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MRCS Part A > Basic Sciences Paper > Flashcards

Basic Sciences Paper Flashcards

1
Q

How many layers does the scalp consist of and what are they?

A

5 layers. Mnemonic ‘SCALP’
Skin
dense Connective tissue
epicranial Aponeurosis
Loose Areolar connective tissue
Periosteum

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2
Q

What is the ‘danger area’ of the scalp?

A

loose connective tissue layer
it contains emissary veins = potential pathway for infection

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3
Q

What is the arterial supply to the scalp?

A

External Carotid Artery - 3 branches; superficial temporal, posterior auricular, occipital
Ophthalmic Artery

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4
Q

What is the deep venous drainage of the scalp?

A

pterygoid venous plexus

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4
Q

What innervates the scalp between the anterolateral forehead and the vertex?

A

Supraorbital nerve - branch of ophthalmic (Trigeminal)

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4
Q

What is the superficial venous drainage of the scalp?

A

superficial temporal, occipital, posterior auricular, supraorbital and supratrochlear veins

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4
Q

What does the Zygomaticotemporal nerve supply?

A

temple area of the scalp
branch of maxillary nerve (trigeminal)

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5
Q

What connects the scalp to the dural venous sinus and creates a potential infection route?

A

emissary veins

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5
Q

What nerve supplies the anteromedial forehead?

A

Supratrochlear nerve - branch of ophthalmic nerve (Trigeminal)

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6
Q

What is the innervation of the scalp?

A

Trigeminal Nerve
Cervical Nerve Roots C2 & C3

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7
Q

What innervates the scalp anterosuperior to the auricle?

A

Auriculotemporal nerve

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8
Q

What innervates the skin posterior to the ear?

A

Lesser occipital nerve - from anterior ramus division of C2

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9
Q

What innervates the occipital region skin?

A

Greater occipital nerve - from posterior ramus of C2

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10
Q

What does the great auricular nerve supply?

A

skin posterior to the ear and over the angle of the mandible

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11
Q

Where does the great auricular nerve derive from?

A

Anterior rami of C2 & C3

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12
Q

What does the Third Occipital Nerve supply?

A

Skin of the inferior occipital region

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13
Q

Where does the third occipital nerve derive from?

A

posterior ramus of C3

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14
Q

What muscle prevents closure of bleeding vessels and surrounding skin in a scalp laceration?

A

Occipitofrontalis muscle

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15
Q

What 3 bones make up the anterior cranial fossa?

A

Frontal Bone
Ethmoid Bone
Sphenoid Bone

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16
Q

What makes up the floor of the anterior cranial fossa?

A

frontal bone, ethmoid bone and the anterior aspects of the body and lesser wings of the sphenoid bone

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17
Q

Where does the falx cerebri attach to?

A

Frontal crest - midline ridge of the frontal bone
and
Crista galli of the ethmoid bone

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18
Q

What is either side of the crista galli?

A

Cribriform plate

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19
Q

What is the role of the cribriform plate?

A

Supports olfactory bulb and has foramina that can transmit vessels and nerves

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20
Q

Where are the anterior ethmoidal foramen and posterior ethmoidal foramen?

A

Larger foramina on the cribriform plate on the ethmoid bone

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21
Q

What travels through the anterior ethmoidal foramen?

A

Anterior ethmoidal artery, nerve, vein

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22
Q

What travels through the posterior ethmoidal foramen?

A

posterior ethmoidal artery, nerve and vein

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23
Q

What is the thinnest part of the anterior cranial fossa?

A

Cribriform Plate

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24
Q

What are the consequences of a cribriform plate fracture?

A
  1. Anosmia - olfactory nerves can be sheared and therefore loss of sense of smell
  2. CSF rhinorrhoea - fracture can tear the meningeal covering of the brain causing CSP leak = clear fluid from nasal cavity
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25
Q

What does the anterior cranial fossa contain?

A

anteroinferior portions of the frontal lobe

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26
Q

What does the middle cranial fossa contain?

A

pituitary gland
temporal lobes

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27
Q

What bones make up the middle cranial fossa?

A

Sphenoid
Temporal bones

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28
Q

What is the saddle shaped bony prominence that supports the pituitary gland and where is it?

A

Sella turcica
in the Middle Cranial Fossa

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29
Q

What are the 3 parts of the sella turcica?

A
  1. tuberculum sellae
  2. hypophysial fossa / pituitary fssa
  3. dorsum sellae
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30
Q

What are the main foramina of the sphenoid bone in the middle cranial fossa?

A
  1. optic canals
  2. superior orbital fissure
  3. foramen rotundum
  4. foramen ovale
  5. foramen spinosum
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31
Q

What travels through the optic canals?

A
  1. Optic Nerves (CN II)
  2. Ophthalmic arteries
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32
Q

What travels through the superior orbital fissure?

A
  1. Oculomotor nerve (CN III)
  2. Trochlear nerve (CN IV)
  3. ophthalmic branch of the trigeminal nerve (CN V1)
  4. Abducens nerve (CN VI)
  5. ophthalmic veins and sympathetic fibres
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33
Q

What travels through the foramen rotundum?

A
  1. maxillary branch of the trigeminal nerve (CN V2)
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34
Q

What travels through the foramen ovale?

A
  1. mandibular branch of the trigeminal nerve (CN V3)
  2. accessory meningeal artery
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35
Q

What travels through the foramen spinosum?

A
  1. Middle meningeal artery
  2. middle meningeal vein
  3. meningeal branch of CN V3
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36
Q

What are the main foramina of the temporal bone in the middle cranial fossa?

A
  1. Hiatus of the greater petrosal nerve
  2. hiatus of the lesser petrosal nerve
  3. Carotid Canal
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37
Q

What travels through the hiatus of the greater petrosal nerve?

A
  1. greater petrosal nerve (branch of the facial nerve)
  2. petrosal branch of the middle meningeal artery
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38
Q

What travels through the hiatus of the lesser petrosal nerve?

A
  1. lesser petrosal nerve - branch of the glossopharyngeal nerve
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39
Q

What travels through the carotid canal?

A
  1. Internal carotid artery
  2. deep petrosal nerve
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40
Q

What is in the posterior cranial fossa?

A

brainstem and cerebellum

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41
Q

What bones make up the posterior cranial fossa?

A
  1. occipital bone
  2. two temporal bones
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42
Q

What is the anteromedial border of the posterior cranial fossa?

A

dorsum sellae of the sphenoid bone

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43
Q

What is the anterolateral border of the posterior cranial nerve?

A

superior border of the petrous part of the temporal bone

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44
Q

What is the posterior border of the posterior cranial fossa?

A

internal surface of the squamous part of the occipital bone

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45
Q

What is the floor of the posterior cranial fossa made of?

A

mastoid part of the temporal bone
squamous, condylar and basilar parts of the occipital bone

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46
Q

What parts make up the brainstem?

A

Medulla oblogata
pons
midbrain

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47
Q

What travels through the internal acoustic meatus?

A
  1. Facial nerve (CN VII)
  2. Vestibulocochlear nerve (CN VIII)
  3. Labyrinthine artery
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48
Q

What are the main foramina in the posterior cranial fossa?

A
  1. Internal acoustic meatus - temporal bone
  2. foramen magnum - occipital bone
  3. jugular foramina - occipital bone
  4. hypoglossal canal - occipital bone
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49
Q

What travels through the foramen magnum?

A
  1. medulla
  2. meninges
  3. vertebral arteries
  4. ascending spinal accessory nerve
  5. dural veins
  6. anterior and posterior spinal arteries
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50
Q

What travels through the jugular foramina?

A
  1. glossopharyngeal nerve
  2. vagus nerve
  3. descending spinal accessory nerve
  4. internal jugular vein
  5. inferior petrosal sinus
  6. sigmoid sinus
  7. meningeal branches of the ascending pharyngeal and occipital arteries
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51
Q

What travels through the hypoglossal canal?

A
  1. hypoglossal nerve
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52
Q

What is MacEwen’s Triangle or supra meatal triangle?

A

Mastoid Fossa - bony landmark of the temporal bone

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53
Q

What is the relevance of the mastoid fossa?

A

Important anatomical landmark in otologic surgery

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54
Q

What is the superior border of the mastoid fossa?

A

Supramastoid crest - extension of the upper border of the posterior root of the zygomatic process

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55
Q

What is the anterior border of the mastoid fossa?

A

Suprameatal Spine (Spine of Henle) - projection of bone at posterosuperior aspect of the opening of the external acoustic meatus

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56
Q

What is the posterior border of the mastoid fossa?

A

Hypothetical vertical line that is tangential to the mid-point of the posterior wall of the external auditory canal

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57
Q

What is the ‘safe area’ for beginning the drilling approach during a cortical mastoidectomy?

A

mastoid fossa/MacEwen’s triangle - no structures other than mastoid antrum underneath

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58
Q

What is a cortical mastoidectomy for?

A

It’s the removal of mastoid air cells especially for severe acute mastoiditis

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59
Q

Where is the infratemporal fossa located?

A

base of skull, deep to masseter muscle

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60
Q

What other fossae is the infratemporal fossa closely related to?

A

pterygopalatine fossa
temporal fossa

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61
Q

What is the lateral boundary of the infratemporal fossa?

A

condylar process and ramus of the mandible bone

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62
Q

What is the Medial border of the infratemporal fossa?

A

lateral pterygoid plate, tensor veli palatine, levator veli palatine and superior constrictor muscles

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63
Q

What is the Anterior border of the infratemporal fossa?

A

posterior border of the maxillary sinus

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64
Q

What is the Posterior border of the infratemporal fossa?

A

carotid sheath

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65
Q

What is the roof of the infratemporal fossa?

A

greater wing of the sphenoid bone

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66
Q

What is the floor of the infratemporal fossa?

A

medial pterygoid muscle

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67
Q

What muscles are located inside the infratemporal fossa?

A

medial and lateral pterygoids

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68
Q

What muscles insert/originate into the borders of the infratemporal fossa?

A

masseter and temporalis muscles

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69
Q

What nerves pass through the infratemporal fossa?

A
  1. Mandibular nerve - branch of trigeminal CN V - motor and sensory
  2. Auriculotemporal, buccal, lingual, inferior alveolar nerves - sensory branches of trigeminal
  3. Chorda tympani - facial nerve CN VII branch
  4. Otic ganglion - parasympathetic neurone cell bodies
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70
Q

What vasculature is contained in the infratemporal fossa?

A
  1. Maxillary artery - terminal branch of external carotid - then gives rise to middle meningeal artery as it passes through
  2. Pterygoid venous plexus
  3. Maxillary vein
  4. Middle meningeal vein
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71
Q

What structure could be damaged by a punch to the side of the skull?

A

the pterion

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72
Q

What is the Pterion?

A

It’s the point where temporal, patietal, frontal and sphenoid bones meet

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73
Q

What can happen if you fracture the pterion?

A

Trauma can damage the MMA, causing raised ICP

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74
Q

What virus commonly causes infectious mononucleosis (glandular fever)?

A

Epstein-Barr virus

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75
Q

What is Epstein-Barr associated with?

A

Infectious mononucleosis
Burkitt’s lymphoma
Nasopharyngeal carcinoma
Autoimmune diseases - SLE

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76
Q

What is the classical triad of infectious mononucleosis?

A

fever
pharyngitis
lymphadenopathy

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77
Q

What imaging needs to be done for infectious mononucleosis?

A

USS Abdo - splenomegaly (consideration for contact sport)
CT abdo - if concerned re: splenic rupture

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78
Q

How long post infection with EBV would you expect to see VCA-IgM (viral capsid antigens) for?

A

3-4 months

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79
Q

When do you expect to see VCA-IgG (viral capsid antigen) post EBV infection?

A

first detected at 2-4 weeks post infection and persist for life

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80
Q

Approx what distance is the duodenal papilla from the pylorus?

A

7-10 cm

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81
Q

What is the pathophysiology of aortic dissection?

A

1st - tear in tunica intima of aorta
2nd - degeneration of tunica media, blood tracks & causes false lumen
3rd -false lumen can occlude aortic branches
4th - blood vessel occlusion & change of blood flow = symptoms

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82
Q

What are the two types of classification system for an aortic dissection?

A

De Bakey (I-III) and Stanford (A & B)

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83
Q

Which classification of aortic dissection do you definitely surgically repair?

A

De Bakey I & II, Stanford A

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84
Q

What are the De Bakey Classifications?

A

I - intima tear @ ascending aorta and dissection affects descending aorta or abdo aorta
II - dissection in the ascending aorta
III - dissection in the descending aorta and propagates distally

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85
Q

What are the Stanford Classifications?

A

A - dissection in ascending aorta +/- aortic arch involvement +/- descending aorta involvement
B - dissection in descending aorta not affecting ascending aorta

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86
Q

What hormonal therapy can be used for carcinoid (neuroendocrine) tumours?

A

somatostatin analogues - octreotide or lanreotide

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87
Q

What hormonal therapy can be used for endometrial carcinomas?

A

Progestins

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88
Q

What hormonal therapy can be used for pheochromocytomas?

A

phenoxybenzamine - blocks alpha receptors

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89
Q

What hormonal therapy can be used for pre-menopausal ER +ve breast cancers?

A

tamoxifen - oestrogen antagonist

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90
Q

What hormonal therapy can be used for post-menopausal ER +ve breast cancers?

A

aromatase inhibitors - anastrozole, letrozole, exemestane

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91
Q

What hormonal therapy can be used for prostatic carcinomas?

A

Gonadotrophin-releasing hormone analogues - goserelin & buserelin

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92
Q

What is the blood supply to the ureter?

A

Upper part - renal artery
Middle - abdominal aorta
Lower - internal iliac arteries

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93
Q

What structures are in the renal hilum posterior to anterior?

A

Renal pelvis - most posterior
Renal artery
Renal vein - most anterior

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94
Q

What hormones & enzymes do the kidneys produce?

A

Erythropoietin
Renin
1,25-dihydroxyvitamin D

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95
Q

What level does the ureter arise at?

A

L2

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96
Q

What is the path of the ureter?

A
  1. Arises at L2
  2. Descends anteriorly to psoas major, adjacent to transverse processes of lx spine
  3. Crosses bifurcation of common iliac artery at roughly SIJ level
  4. Travels under uterine artery or vascular deferens
  5. Enters bladder at level of ischial spines
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97
Q

What is the innervation of the ureter?

A

Ureteric plexus & sensation are from T12-L2
Pain refers to those dermatomes

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98
Q

What surface of the bladder is covered by peritoneum?

A

Only superior surface

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99
Q

What causes the detrusor muscle to relax/contract?

A

Autonomic nervous system
Parasympathetic = contract and urination - pelvic nerve S2-4 act on muscarinic (M3) receptors
Sympathetic = relaxation and urine storage - inferior hypogastric plexus T12-L2 act on adrenergic beta receptors

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100
Q

What extra urethral sphincter do men have?

A

Internal urethral sphincter

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101
Q

What are the 3 layers of the detrusor muscle?

A

Inner longitudinal
Middle circular
Outer longitudinal

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102
Q

What causes the external urethral sphincter to relax/contract?

A

Conscious control - somatic
Pudendal nerve S2-4 on nicotinic receptors

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103
Q

What causes the external urethral sphincter to relax/contract?

A

Conscious control - somatic
Pudendal nerve S2-4 on nicotinic receptors

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104
Q

Blood supply to AV node

A

Right coronary artery

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105
Q

Define expiratory reserve volume

A

Additional amount of air that can be exhaled after normal exhalation

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106
Q

Ductus venosus function

A

Shunt between umbilical vein and IVC
Delivers oxygenated blood from placenta to heart
Closes and becomes ligamentum venosum on underside of live

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107
Q

Commonest cause of osteomyelitis in non-sickle cell patient

A

Staph aureus

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108
Q

Define inspiratory reserve volume

A

Max vol of air that can be inspired in excess of normal inspiration

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109
Q

Which part of nephron is impermeable to water

A

Ascending loop of Henle

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110
Q

Useful landmark for femoral artery

A

Mid-inguinal point

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111
Q

Common cause of narrow anion gap metabolic acidosis

A

Type 1 renal tubular acidosis

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112
Q

Locations of ectopic testis

A

Perineal
Superficial inguinal.pouch
Femoral canal
Pre-penile

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113
Q

Superficial peroneal nerve supplies

A

Muscles of lateral compartment - eversion
Cutaneous sensation to foot dorsum except 1st dorsal Web space

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114
Q

Deep peroneal nerve

A

Muscles of anterior compartment
Sensation to 1st webbed space

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115
Q

Pharyngeal pouch

A

Defect between thyropharyngeus and cricopharyngeus
Killans dehiscence

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116
Q

MOA aliskiren

A

Direct renin inhibitors
For me of essential hypertension

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117
Q

Where is stellate ganglion located?

A

Between T1 and C8

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118
Q

Damage to stellate ganglion causes

A

Horners Syndrome

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119
Q

Causes of horners

A

Apical lung tumours (pancost)
First rib #
UL injury - klumpskes

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120
Q

Diaphragm insertion

A

Central tendon

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121
Q

Level abdominal.aorta passes through diaphragm

A

T12

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122
Q

IVC goes through diaphragm.

A

T8

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123
Q

Level oesophagus passes through diaphragm.

A

T10

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124
Q

Bleeding in clavicopectoral fascia is caused by which artery

A

Thoraco-acromial artery

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125
Q

Which is the commonest site of obstruction in cerebrospinal fluid flow

A

Cerebral aqueduct of sylvius

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126
Q

ACID –> EGGT hypersensitivity reaction

A
  1. A -Atopy/anaphylactic - IgE
  2. C - Cyto - IgG
  3. I - Immune - G
  4. D - delayed T cells
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127
Q

Primary metabolic effect of adrenaline

A

Glycolysis

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128
Q

Primary metabolic effect of adrenaline

A

Glycolysis

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129
Q

What forms tendinous part of diaphragm?

A

Septum transversum

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130
Q

What forms muscular part of diaphragm?

A

2 pleural peritoneal membranes and peripheral body wall muscle

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131
Q

What forms the crura of the diaphragm?

A

Mesentery of oesophagus

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132
Q

Structures passing diaphragm at T8

A

IVC
Right phrenic

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133
Q

Structures passing through diaphragm T10

A

Oesophagus
Vagus nerve

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134
Q

Structures passing through the diaphragm at T12

A

Abdo aorta
Thoracic duct

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135
Q

What are Aschoff-Rokitansky sinuses associated with?

A

Chronic cholecystitis

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136
Q

Annular pancreas

A

Embryology anomaly
Duodenal obstruction
2nd part of duodenum is completely/incompletely encased by the pancreas
Narrowing and dilation of prox dueodenum

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137
Q

Becks triad for tamponade

A

Hypotension
Muffled heart sounds
Distended neck veins

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138
Q

Nasolacrimal duct drains into…

A

Inferior meatus

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139
Q

What hormone is responsible for hydroxylation for vit D3?

A

PTH

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140
Q

levator ani muscles

A

Pubococcygeus
Puborectalis
Ileococcygeus

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141
Q

TFTs for Graves

A

Decreased TSH
Raised T4 and T3

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142
Q

S&S of small bowel atresia

A

Neonate
Bilious vomiting
Passed meconium but nothing since
Abdo distension
Dilated bowel loops on AXR

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143
Q

MOA UV light on micro organisms

A

Forms pyrimidine dimers and alter form of DNA and interfere with normal base pairing during DNA synthesis

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144
Q

Takayasu’s arthritis

A

Large vessel inflammatory vasculitis affecting aorta & branches
Women over 40

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145
Q

Which factor is involved in extrinsic coag cascade

A

7

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146
Q

Brain cyst after infarction caused by

A

Liquidative necrosis

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147
Q

Most characteristic histological feature of invasive ductal carcinoma

A

Pleomorphism
Atypical ductal cells

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148
Q

Most characteristic histological feature of invasive ductal carcinoma

A

Pleomorphism
Atypical ductal cells

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149
Q

Practical treatment for hereditary angio-oedema

A

FFP

Ideally you need recombinant C1 esterase inhibitor but this is often not immediately available

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150
Q

Common organism for fourniers gangrene

A

Mixed flora

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151
Q

Most likely complication of chronic suppurative otitis media

A

Lateral sinus thrombosis

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152
Q

Formation of male external genitalia requires

A

Dihydrotestosterone

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153
Q

Vessel anterior to medial malleolus

A

Great saphenous vein

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154
Q

Cervix lymph drainage

A

Internal iliac lymph nodes

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155
Q

What activates classical complement pathway?

A

Immunoglobulins

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156
Q

SMA passes posterior to what?

A

Splenic vein
Neck of pancreas

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157
Q

Staghorn calculi

A

Recurrent UTIs
Urease producing bacteria
Struvite or calcium carbonate
Radio-opaque

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158
Q

Partial rectal prolapse in kids mx

A

Most resolve with Conservative management

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159
Q

Portal vein formed by

A

Splenic and SMV

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160
Q

Parasympathetic nerve fibres leave CNS

A

CN 3, 7, 9, 10
2nd, 3rd, 4th sacral segments of spinal cord

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161
Q

What sits in the superficial perineal space in males?

A

Corpus spongiosum

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162
Q

What drains the anterior region of the heart?

A

Great cardiac vein

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163
Q

Where does the great cardiac vein run down?

A

Anterior interventricular groove

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164
Q

Stab wound just below right nipple will damage what?

A

Pulmonary trunk
Other middle mediastinal contents

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165
Q

Primary structure forming posterior wall of inguinal canal

A

Conjoint tendon

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166
Q

Role of pneumotaxic centre

A

Upper part of pons
Controls rate and pattern of breathing
Regulates amount of air that can be taken into each breath

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167
Q

Number of secondary ossification centres between C3-L5

A

5

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168
Q

Blood vessel causing oesophageal varices

A

Left gastric vein

169
Q

Left testicular vein drains into

A

Left renal vein

170
Q

Right testicular vein drains into

A

IVC

171
Q

Which pharyngeal arch and associated nerve is associated with a sinus opening into laryngeal cartilage & laryngeal musculature?

A

4th arch
Vagus nerve

172
Q

MOA lidocaine

A

Blocks intracellular sodium channels
Stops influx of Na ions into cells

173
Q

CN through jugular foramen

A

9, 10, 11

174
Q

Antecubital fossa contents lateral to medial

A

TAN
Tendon, artery, nerve

175
Q

Cremaster muscle arises from

A

Internal oblique & inguinal ligament

176
Q

Space fluid collects in a testicular hydrocele

A

Tunica vaginalis

177
Q

Axillary nerve innervation motor

A

Deltoid
Teres minor
Long head of triceps

178
Q

Cells in Hodgkins lymphoma

A

Reed sterberg cells
Large abnormal lymphocytes containing more than one nucleus

179
Q

Ligament present on posterior hilum of the spleen

A

Splenorenal ligament
Aka leinorenal/phrenosplenic ligament

180
Q

Anterior inferior cerebellar artery syndrome

A

Aka lateral pontine stroke
Ipsilateral- nystagmus, hearing loss, limb ataxia,loss of pain/temp on face, facial weakness
Contralateral hemiplegia, hemiparesis, loss of pain/temp on body

181
Q

In fetal circulation what delivers oxygenated placental blood to fetal heart

A

IVC

182
Q

Cleft lip due to

A

Failure of medial nasal prominence to fuse with maxillary prominence on one or both sides due to inadequate migration of neural crest cells

183
Q

Ductus arteriosus connects what

A

Pulmonary artery to proximal descending aorta

184
Q

Multiple myeloma

A

Bence Jones proteins
High calcium
Anaemia
Lytic bone lesions

185
Q

Ganglion if damaged causes loss of taste sensation anterior 2/3 of tongue

A

Geniculate ganglion - CN 7

186
Q

Damage to Otic ganglion

A

Innervation parotid gland
Frey syndrome- salivation induces perspiration at parotid region
Salivatory nucleus

187
Q

How many ligaments stabilise the TMJ

A

3

188
Q

Innervation of the TMj

A

Auriculotemporal nerve
Cn V3

189
Q

Role of secretin

A

Secreted in response to protein products, bile acid, fatty foods and increased acidity in duodenum
Acts on pancreas and stimulate bicarb production
Neutralises chyme

190
Q

MAP calculation

A

Diastolic pressure - (systolic-diastolic)/3

191
Q

CPP calculation

A

MAP-ICP

192
Q

Which muscle inserts into gluteal tuberosity of femur

A

Gluteus maximus

193
Q

What vessel supplies fetus with oxygen and nutrients from placenta?

A

Umbilical vein

194
Q

Maturity onset diabetes of the young

A

Monogenic diabetes
Autosomal dominant
Non-ketotic
Beta cell dysfunction
Onset < 25

195
Q

Osteosarcoma

A

Most common primary bone tumour
Men < 30
Long bones
Spread by blood to lungs

196
Q

Angiosarcoma of liver

A

Non specific abdo pain, ascites
Elevation of liver enzymes, anaemia
Hypodemse that becomes hyperdense after contrast
PVC, arsenic and steroid exposure

197
Q

Autonomic supply of parotid gland

A

Sympathetic- sup.cervjcal ganglion
P/Sympathetic - glossopharyngeal through otic ganglion

198
Q

Nerve fibres carried by spinothalamic tract

A

2nd order fibres
Pain and temp

199
Q

MOA botox

A

Blocks acetylcholine receptors
Binds presynaptically
Muscles relax
CNS and peripheral

200
Q

Artery ligated during Whipples

A

Superior pancreaticoduodenal artery

201
Q

Anaplastic thyroid cancer cells

A

Biphasic tumour population
Prominent mitotic figures
Necrotic and inflammatory background
Highly cellular
Single cells or focal atypical cells

202
Q

What forms the inguinal ligament

A

External oblique aponeurosis

203
Q

Organism causing staghorn renal calculus

A

Proteus mirabilis

204
Q

Hangman’s fracture

A

Pedicles of C2

205
Q

Vein drains lateral wall of left ventricle

A

Left marginal vein

206
Q

What can maintain a PDA after birth?

A

Prostaglandins

207
Q

Gene associated with male breast cancer

A

BRCA2

208
Q

Thymus originates from

A

Ventral portion of 3rd pharyngeal pouch

209
Q

Enzyme responsible for protein digestion

A

Trypsin

210
Q

During midget rotation what is the axis of rotation?

A

SMA

211
Q

Direction of fibres of external and internal oblique

A

External = inferomedial
Internal = superomedially

212
Q

Blood supply to greater curvature of stomach

A

Left and right gastroepiploic arteries

213
Q

Renal amyloidosis

A

Mesangial apple-gree birefringence on Congo red staining under polarised light

214
Q

Gold standard treatment in case of BBB with low HR

A

Pacing and resync therapy

215
Q

Axonotmesis

A

Damage to axon and myelin sheath
Follows stretch or crush injury
Common after closed fractures or dislocations

216
Q

Neuroblastoma

A

Kids < 5
Vague abdo symptoms
Adrenal gland
Lytic bone lesions
Surgery +/- chemo

217
Q

Neuroblastoma

A

Kids < 5
Vague abdo symptoms
Adrenal gland
Lytic bone lesions
Surgery +/- chemo

218
Q

Invasive ductal carcinoma

A

50-60 years
80% breast ca
Axillary lymphadenopathy
Irregular spiculated hyperdense lesion with micro calcification

219
Q

Max safe dose of bupivacaine with or without adrenaline

A

2mg/kg
Max 150mg

220
Q

Medication to give with septic shock with hypotension refractory to 2 litres fluid resus

A

Noradrenaline

221
Q

Most common site of foreign body aspiration

A

Right inferior bronchus

222
Q

Osteosarcoma

A

Bone malignancy kids and adolescents
“Sun burst” appearance x-ray
Long bones at metaphysis
Pain worse at night
Limp
Pain fever swelling

223
Q

Iron deficiency anaemia

A

Low Hb low mcv
Low ferritin
High transferrin

224
Q

Nerve most at risk from skull fracture to petrous part of temporal bone

A

Facial nerve

225
Q

Ewings sarcoma

A

Boys 10-20 years
Femoral diaphysis then pelvis, ribs, vertebrae
Swelling, pain, systemic features
Onion skin appearance

226
Q

Intraductal papilloma

A

Benign tumour
35-55 women
Bloody or clear nipple d/c
Central lump behind nipple
Round mass and well circumscribed
Fibrovascular core covered with epithelial and myoepithelial cells

227
Q

Paraphimosis

A

Prepuce is retracted beyond the glans and cannot be replaced
Prevents venous return
Swelling and oedema of glans

228
Q

Phimosis

A

Foreskin is tight
Retraction difficult

229
Q

Killians dehiscence

A

Zenkers diverticulum
Between thyropharyngeus and cricopharyngeus muscles

230
Q

Vessels arising from arch of aorta

A

Left subclavian
Left common carotid
Brachiocephalic trunk

231
Q

Embryological origin of trachea

A

Foregut endoderm
4th gestational week

232
Q

extending from nasofrontal suture through the superior medial wall of maxillary bone, inferior laterally through lacrimal bone then along inferior orbital rim

A

Le Fort 2

233
Q

Transverse fracture extending from nasofrontal suture along medial wall, floor, lateral wall of orbit into zygomaticofrontal junction and zygomatic arch

A

Le Fort 3

234
Q

Consent form 2

A

Kid lacks capacity for procedure
Consent from parent

235
Q

Consent form 2

A

Kid lacks capacity for procedure
Consent from parent

236
Q

GCS eyes

A

4 - spontaneously
3 - to voice
2 - to pain
1 - none

237
Q

GCS verbal

A

5 - orientated
4 - confused
3 - inappropriate words
2 - incomprehensible sounds
1 - none

238
Q

GCS motor

A

6 - obeys commands
5 - localises to pain
4 - withdraws from pain
3 - flexion to pain
2 - extension to pain
1 - none

239
Q

Perilunate dislocation

A

Young adults
High energy trauma
Wrist hyperextension
Median nerve palsy
Dorsal displacement of the capitate, normal radiolunate alignment
AVR risk, compartment syndrome risk

240
Q

Argon beam laser use

A

GI ulcers
Ophthalmology
Dermatology
Port wine stain rx

241
Q

Which 4 CN supply parasympathetic nervous system

A

3, 7, 9, 10

242
Q

What does the ciliary ganglion connect?

A

CN 3 to eye
P/sympathetic

243
Q

What does the sphenopalatine ganglion connect?

A

CN 7 to lacrimal gland

244
Q

What does submandibular ganglion connect?

A

CN 7 to submandibular and sublingual glands

245
Q

What does the otic ganglion connect?

A

CN 9 to parotid gland

246
Q

What veins form the axillary vein?

A

Basilic and brachial

247
Q

Mirizzi’s syndrome

A

Gallstones impacted in cystic duct or neck of gallbladder causing external compression and obstruction of common hepatic duct

248
Q

Codmand triangle x-ray feature

A

Osteosarcoma

249
Q

Hydrocele criteria

A

Painless
Difficult to feel testis
Chronic
Slowly increases with time

250
Q

Right renal artery in relation to IVC and right renal vein

A

Posterior to IVC
Superior to renal vein

251
Q

Where does the glossopharyngeal nerve arise from?

A

Anterior medulla
Groove between inferior cerebellar peduncle and the olive

252
Q

Part of brain which limits inspiration

A

Pneumotaxic centre

253
Q

First site of haematopoiesis

A

Yolk sac

254
Q

Lateral border of Guyon’s canal

A

Hamate
Transverse carpal ligaments
Flexor tendons

255
Q

Lacrimal artery branch of

A

Ophthalmic artery

256
Q

Foveolar cells

A

Surface mucous cells in stomach
Secrete mucus and bicarbonate

257
Q

Action of bile salts for food digestion

A

Emulsification of fat

258
Q

What artery arises from supracondylar Femoral artery?

A

Descending genicular artery

259
Q

Which artery is a branch of the splenic artery and supplies the stomach?

A

Left gastroepiploic artery

260
Q

Cells responsible for erythropoietin production

A

Interstitial cells in peritubular capillaries

261
Q

Dorsal column carries

A

Ipsilateral proprioception, light touch, vibration

262
Q

Spinothalamic tract lesion

A

Contralateral loss of pain and temperature sensation

263
Q

Patent ductus arteriosus connects

A

Prox descending aorta to main pulmonary artery

264
Q

Vertebral artery arises from

A

Subclavian artery

265
Q

Half life of free T3 in blood

A

1 day

266
Q

Clear cell carcinoma

A

Most common renal cancer
Smokers
Responds to cytogenetics therapy IL-2

267
Q

Nerve commonly injured during axillary clearance for breast cancer

A

Intercostobrachial nerve

268
Q

External acoustic meatus and tympanic membrane embryological origin

A

1st ectodermal cleft

269
Q

Inferior border of quadrangular space

A

Teres major

270
Q

Basilar artery terminates by dividing into..

A

Posterior cerebral artery

271
Q

Marjolins ulcer

A

Chronic venous ulcer that’s undergone malignant change
SCC
Longstanding ulcer tender and thickened edges

272
Q

Assessing parathyroid adenoma pre-op scan

A

Sestamibi scan

273
Q

Occipital artery is a branch of

A

External carotid

274
Q

Occipital artery is a branch of

A

External carotid

275
Q

What nerve runs posterior to the lateral malleous and what does it supply?

A

Sural nerve
Posterolateral aspect of bottom 1/3 of leg and lateral foot

276
Q

Anal verge lymph drainage

A

Superficial inguinal lymph nodes

277
Q

What drains to external iliac lymph nodes

A

Glans Penistone
Clit
Prostate
Fundus of bladder
Cervix and upper vagina

278
Q

What drains into internal iliac lymph nodes

A

Pelvic viscera
Perineum
Membranous and cavernous urethra
Butt
Thigh

279
Q

What can be given to patients with von Willebrand pre op

A

Desmopressin

280
Q

Management addisonian crisis

A

IV hydrocortisone and saline

281
Q

What UTI abx causes pulmonary fibrosis

A

Nitrofurantoin

282
Q

Ludwig Angina

A

Rapid progressive gangrenous b/l cellulitis of the submandibular space
Risk of airway compromise
Can affect sublingual and submaxillary space

283
Q

Nerves controlling ejaculation

A

Hypogastric plexus T12-L2
Sympathetic

284
Q

What muscles control erection?

A

Parasympathetic
Pelvic nerves
S2-4

285
Q

What x-ray view is needed if median nerve injury suspected with a wrist trauma?

A

True lateral view

286
Q

Best investigation for renal vein thrombosis

A

CT angio

287
Q

Yersinia enterocolitica

A

Gram negative bacillus
Diarrhoea, mesenteric adenitis, terminal ileitis, pseudo-appendicitis
4-7 days after exposure
Skin rash, joint pains, sepsis

288
Q

Commonest breast cancer

A

Invasive ductal carcinoma

289
Q

Main parathyroid blood supply

A

Inferior thyroid artery

290
Q

Innervation of strap muscle

A

Ansa cervicalis

291
Q

Relation of left common iliac vein to right iliac artery

A

Left Iliac vein passes posteriorly to right iliac artery

292
Q

Tracheostomy landmarks

A

Suprasternal notch and cricoid cartilage

293
Q

Where does chorda tympani exit the middle ear

A

Petrotympanic fissure

294
Q

Notochord in adult

A

Nucleus pulposus

295
Q

Role of median umbilical ligaments

A

Carry deoxygenated blood from fetus to placenta

296
Q

Causes vasoconstriction on efferent arterioles

A

Angiotensin 2

297
Q

Marker positive in most lymphomas

A

CD20

298
Q

Marker positive in most lymphomas

A

CD20

299
Q

Amyloidosis associated with multiple myeloma

A

AL amyloidosis

300
Q

Amyloid appears under microscope with Congo red

A

Green with red birefringence

301
Q

Marfan defect

A

Fibrillin-1 gene

302
Q

Commonest lung cancer in non smokers

A

Adenocarcinoma (subtype of non small cell)

303
Q

Artery for coronary artery bypass

A

Internal mammary artery

304
Q

What muscle does the parotid pass through?

A

Buccinator

Crosses masseter

305
Q

Plummer vinson syndrome associated with

A

Iron deficiency anaemia

306
Q

Porta hepatis contains

A

Portal vein
Hepatic artery
Common hepatic duct

307
Q

Cohort studies usually assess what type of risk

A

Relative risk

308
Q

How can you manage a cystic duct leak?

A

Ercp and stent

309
Q

Middle mediastinum contents

A

Pericardium
Heart
Aortic root
Arch of azygos
Main bronchi

310
Q

Posterior mediastinum

A

Oesophagus
Thoracic aorta
Azygos vein
Thoracic duct
Vagus
Sympathetic nerve trunks
Splanchic nerves

311
Q

Investigate pharyngeal pouches

A

NOT OGD
Fluroscopy swallowing studies

312
Q

Posterior wall of Femoral canal

A

Pectineal ligament

313
Q

Collateral venous systems alternate to SVC

A

Azygos
Internal mammary
Long Thoracic with connections to Femoral and vertebral veins

314
Q

Trotters triad for nasopharyngeal cancer

A

Unilateral conductive hearing loss
Ipsilateral face and ear pain
Ipsilateral soft palate paralysis
EBV association

315
Q

Cells secrete gastric acid

A

Parietal cells

316
Q

Low Mg2+ causes

A

Diuretics
TPN
Diarrhoea
Alcohol
Low K, low Ca

317
Q

Central tendon of diaphragm formed by

A

Septum transversum

318
Q

Most superficial structure on parotid gland

A

Facial nerve

319
Q

Another name for herceptin

A

Trastuzumab

320
Q

Vessels in posterior triangle of neck

A

External jugular vein
Subclavian artery

321
Q

Abx inhibiting cell wall formation

A

Penicillin
Cephalosporins

322
Q

Inhibit protein synthesis

A

Aminoglycosides - misreading of mRNA
Chloramphenicol
Macrolides
Tetracycline
Fusidic acid

323
Q

Abx which inhibit DNA synthesis

A

Quinolones
Metronidazole
Sulphonamides
Trimethoprim

324
Q

Subacute thyroiditis

A

High T4
Painful goitre
Raised esr
Reduced uptake on iodine131 scan
Self limiting
Nsaids
Low tsh

325
Q

What do sharpeys fibres attach to

A

Perisoteum
They are strong collagenous fibres
Attachment for muscles and tendons

326
Q

Cystic artery is a branch of

A

Right hepatic artery

327
Q

Bile production rate

A

150-1500ml per 24

328
Q

First branch of external carotid artery

A

Sup thyroid artery

329
Q

Homans op

A

For lymphandenopathy
Preserves overlying skin which must be in good condition
Reduces limb circumference by 1/3

330
Q

What drug increases gastric emptying rate in vagotomised stomach?

A

Erythromycin

331
Q

ABPI >1.2

A

Vessel calcification ie DM

332
Q

ABPI 0.3-0.5

A

Significant stenosis
Compression bandage contraindicated

333
Q

Venous ulcer

A

Above medial malleous
Indolent with basal granulation
Scarring
Non ischaemic edges
Haemosiderin deposition in gaiter area

334
Q

Miller Cuff in vascular surgery

A

Vein boot
If vein isn’t long enough for entire conduit then vein can be attached to end of PTFE graft
Better patency than PTFE alone

335
Q

Antibodies in hashimotos

A

Thyroid peroxidase antibodies

336
Q

Antibodies in graves

A

TSH receptor antibodies
Sometimes thyroid peroxidase

337
Q

Commonest thyroid cancer

A

Papillary

338
Q

Psammoma bodies (calcification), orphan Annie nuclei is what pathology?

A

Papillary thyroid cancer

339
Q

Papillary cancer mets to

A

Lymph spread
Laterally located

340
Q

Follicular thyroid cancer spread

A

Haematogenously

341
Q

Follicular cancer presentation

A

Discrete nodule
Well encapsulated

342
Q

Tumour of parafollicular cells

A

Medullary thyroid cancer

343
Q

Medullary thyroid cancer

A

Calcitonin raised
MEN2A
Lymph or blood spread
Don’t respond to radioiodine

344
Q

Outermost layer spermatic cord is derived from

A

External oblique aponeurosis

345
Q

Male urethra part surrounded entirely by bucks fascia

A

Spongiose part

346
Q

Renal stones associated with chemotherapy

A

Uric acid stone
Radiolucent

347
Q

Anal fissures associated with

A

STD
IbD
Leukaemia
Tb
Previous anal surgery

348
Q

Glut max innervation

A

Inferior gluteal nerve

349
Q

Cowden disease

A

PTEn mutation
Macrocephaly
Intestinal hamartomas
Risk of colorectal cancer
Breast cancer
Thyroid cancer
Uterine cancer

350
Q

Specificity

A

True negative ÷ (true negative + false positive)

351
Q

Holstein Lewis #

A

Distal 1/3 humerus #
Damage to radial nerve

352
Q

Watercress farming associated with

A

Fasciola hepatica

353
Q

Salter Harris Classification
Type 1 & 2

A
  1. Transverse through growth plate
  2. Through growth plate to metaphysis
354
Q

Salter Harris Classification
Type 3 & 4 & 5

A
  1. Through growth plate and epiphysis, metaphysis spared
  2. Involves growth plate, metaphysis, epiphysis
  3. Compression fracture of growth plate
355
Q

B/l acoustic neuroma associated with

A

Neurofibromatosis type 2

356
Q

Right subclavian originates from which aortic arch

A

4th

357
Q

Middle rectal artery is a branch of

A

Internal iliac artery

358
Q

Superior rectal artery is a branch of

A

IMA

359
Q

Inferior rectal artery is a branch of

A

Internal pudendal artery

360
Q

Cervical branch of facial nerve innervates

A

Platysma

361
Q

Ansa cervicalis innervates

A

S. Sternohyoid
O. Omohyoid
S. Sternothyroid

362
Q

Massive PE mx

A

Thrombolysis with alteplase 50mg

363
Q

Which breast cancer classical mets to opposite breast

A

Invasive lobular carcinoma

364
Q

Femoral canal borders

A

Laterally femoral vein
Medially lacunar ligament
Anteriorly inguinal ligament
Posterior pectineal ligament

365
Q

Giardia lamblia presentation

A

Fat malabsorption (floating poo)
Greasy poo
Resistant to chlorine therefore transfer in pools

366
Q

Stensens duct

A

Secretions from parotid gland
Enters mouth at 2nd molar

367
Q

Boas sign

A

Acute cholecystitis
Hyperaesthesia tip of right scapula

368
Q

Adductor canal compression

A

Young men
Compression of femoral artery by musculotendinous band from adductor magnus muscle
Weak popliteal pulse
Leg pain from.walking, reduced hair and reduced muscle mass in leg

369
Q

What muscle separates the subclavian artery and vein

A

Anterior scalene muscle

370
Q

Contents of carotid sheath

A

Common carotid
Internal carotid
Internal jugular
Vagus

371
Q

What stiulates prolactin release?

A

TRH
Thyrotropin releasing hormone

372
Q

Positive predictive value

A

True positive ÷ (TP + false positive)

373
Q

Intestinal malrotation with volvulus rx for neonate

A

Ladds procedure
Laparotomy and division of adhesional bands

374
Q

Psoas insertion

A

Lesser trochanter

375
Q

Syringomyelia selectively affects

A

Spinothalamic tracts

376
Q

GIST derived from

A

Interstitial pacemaker cells of cajal

377
Q

Erythropoietin produced

A

Interstitial cells kidney

378
Q

Granulomatous inflammation in arterial wall is a hallmark of

A

GCA

379
Q

Replacement of stratified squamous epithelium with columnar epithelium containing goblet cells is an example of

A

Metaplasia

380
Q

MOA succinylcholine

A

Binds and activates nicotinic acetylcholine receptors on muscle cell membrane
Brief depolarisation = muscle contraction

381
Q

Physiological role of gall bladder

A

Concentration of bile

382
Q

Enzyme causing pancreas auto digestion in pancreatitis

A

Trypsin

383
Q

Posterior lobe of cerebellum role

A

Fine motor control of extremities
Dysmetria, intention tremors

384
Q

Anterior lobe of cerebellum

A

Prone to damage from chronic alcohol abuse

385
Q

Morison’s pouch

A

Common fluid site for collection after cholecystectomy
Aka hepatorenal recess
In supracolic compartment

386
Q

Cliostazol

A

Rx for I/M claudication in PAD
Prevents activation of myosin light chain kinase for smooth mm contraction = vasodilation
No significant heart impact

387
Q

Marker for deep surgical site infections

A

Procalcitonin - bacterial infection marker

388
Q

Histological feature associated with OP

A

Increased osteomyelitis lacunae and canaliculi

389
Q

Hormone responsible for prostate enlargement

A

Dihydrotestosterone

390
Q

Pfannestiel layers outside to inside

A

Skin
Superficial fascia
Anterior rectus sheath
Rectus abdominis
Trans fascia
Extraperitoneal connective tissue
Peritoneum.

391
Q

Average stroke volume

A

70ml/beat

392
Q

Hallmark histology of AAA

A

Disruption of elastic lamellae

393
Q

Transporter to reabsorb calcium in kidneys stimulated by PTH

A

Type 5
Transient receptor potential vanillin type 5

394
Q

Cells playing central role in granuloma formation

A

Macrophages

395
Q

Upper 1/3 rectum lymph nodes drainage

A

Inferior mesenteric lymph nodes

396
Q

Autoimmune hepatitis

A

Antismooth muscle and ANA
Definitive diagnosis by liver biopsy

397
Q

NV structures passing through parotid superficial to deep

A

Nerve then Ext. Jugular vein then artery

398
Q

Lymph drainage of lower rectum

A

Internal iliac lymph nodes

399
Q

Primary mechanism for maintaining voltage in nerve cell

A

Na-K pump

400
Q

Abdo wall layer that becomes internal spermatic fascia

A

Transversalis fascia

401
Q

Muscle attached to inferior angle of scapula

A

Rhomboid minor

402
Q

Cystic artery origin

A

Right hepatic artery

403
Q

Origin of CN 9

A

Medulla oblongata

404
Q
A

L

405
Q

Blood supply to anterior abdo wall

A

Inferior epigastric artery

406
Q

Scalp layer likely involved in scalp avulsion injury

A

Loose areolar tissue layer

407
Q

Structure medial to right phrenic nerve

A

Vagus nerve

408
Q

Formation of AV septal defect cause

A

Failure of endocardial cushion fusion

409
Q

Iron absorption small bowel location

A

Duodenum

410
Q

RSI anaesthetic

A

Etomidate

411
Q

Left gastroepiploic artery is a branch of

A

Splenic artery

412
Q

Line on x-ray for pelvic organ prolapse

A

Pubococcygeal line

413
Q

Myelomenigocele can be associated with

A

Chiari type 2 malformation

414
Q

Thyroglossal duct cyst histology

A

Resp type epithelium
Follicles in cyst wall

415
Q

Where are B1 and B2 adrenoreceptors located

A

B1 cardiac ventricles
B2 blood vessels, gut smooth wall, bronchial smooth muscle, bladder wall

416
Q

3rd part of duodenum

A

Posterior to sup.mesenteric vessels
Overlies aorta and IMA

417
Q

Primary method for regulating intracellular pH

A

Cytoplasmic proteins

418
Q

What nerves run anterior and posterior to the hila of left and right lungs

A

Anterior = phrenic
Posterior = Vagus

419
Q

Carcinoid syndrome

A

Due to serotonin secretion
Can affect heart = cardiac valve lesions

420
Q

Anatomical location of transverse perineal muscles

A

Between urethra and anus

421
Q

Actinic keratosis

A

Premalignant to SCC
Older lighter skin
Sun exposure
Discrete, well circumscribed, red, macilopapular
Curettage and electrodessication
Liquid nitrogen and 5-FU rx

422
Q

Hyperacute reaction is mediated by

A

Complements

423
Q

Biochemical markers of hemolytic anaemia

A

Increased unconjugated hyperbilirubinaemia, excretion of urobilinogen, stercobilinogen in faeces

424
Q

Cryoprecipitate contains

A

Fibrinogen
Factor 8
Von willebrand

MRCS Part A (1 decks)

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