Block 11 Flashcards

Question

Which of the following is the commonest activator of fibrinolysis? Epsilon aminocaproic acid Factor XII Protein C tPA Tranexamic acid

Answer 1

EACA inhibits fibinolytic syndrome Protein C inhibts blood clotting Factor XII activates the fibrinolytic syndrome by promoting formation of kallikrein from prekallikrein tPA is the commonest activator of fibrionlysis Tranexamic acid reduces fibrin dissolution by inhibiting plasminogen activation and fibrinolysis

Answer 2

Proliferation of new capillaries, with fibroblasts and new collagen formation

Answer 3

Bilirubin \>30

Answer 4

Ligamentum patellae which is the single strong tendon of quadriceps femoris.

Answer 5

Normal distribution Unimodal Mean = mode

Answer 6

Leucoplakia

Answer 7

Erythroplakia

Answer 8

Passes anterior to the ala of the sacrum, under cover of the common iliac vessles and joins the S1 ventral rami deep to piriformis

Answer 9

Passes under the common iliac vessels

Answer 10

Most common malignant oral cavity cancer Cervical LNs common at presentation. Usually involves anterior triangle nodes first before spreading to posterior triangle nodes.

Answer 11

Smoking Betel nut chewing EtOH Leucoplakia

Answer 12

Internal mammary artery

Answer 13

Increase in portal vein pressure of \>10mmHg

Answer 14

Suspensory muscle of the duoenum is a thin sheet of muscle derived from the right crus of the diaphragm, it suspends the fourth part of the duodeum from the posterior abdominal wall

Answer 15

Most common type is 21-hydroxylase deficiency. Results in low cortisol, triggers ACTH release and adrenal hyperplasia. Salt-losing crises can occur with very low cortisol levels. Progesterone cannot be metabolised as the enzyme deficiency increases the manufacture of 17a hydroxyprogesterone and androgens which cause virilisation/precocious sexual development. Late onset disease can be due to partial enzyme deficiency.

Answer 16

Protease secretions

Answer 17

Transverse cervical supplies blood to traps Levator scapulas and rhomboids receive blood from dorsal scapular artery Lat dorsi receives blood from thoracodorsal artery

Answer 18

Sepsis- control sepsis N- nutrition A- anatomy, delineate anatomy using contrast radiology. P- plan as in management plan

Answer 19

Uterine artery lies anterior and superior to the uretur at the lateral portion of the fornix

Answer 20

2cm superior to ischial spine

Answer 21

In its resting state, the inside of a neurone is rich in chloride ions and a lesser amount of potassium ions. The outside is rich in sodium ions

Answer 22

After 24 horus Infection Dislodgement of clot/slough Ligature erosion

Answer 23

At 2 weeks as the majority of lax capsules will tighten by this stage

Answer 24

GB IVC Ligamentum teres Ligamentum venosum Porta hepatis

Answer 25

Acts on the liver to stimualte glycogenolysis by increasing intracelllular cAMP High concentration of serum amino acids can also stimulate the release of glucagon

Answer 26

Basilic vein lies medial to biceps tendon in the cubital fossa and is medial to the medial cutaneous nerve of the forearm.

Answer 27

Haematoma formation Marginal mandibular nerve palsy Lingual nerve palsy Hypoglossal nerve damage

Answer 28

Cholesterosis

Answer 29

Urea breath test 95% sensitivity, 96% specificity

Answer 30

TMJ is a synovial joint situated between the condyle of the mandible below and the mandibular fossa above. Although it is a synovial joint, it is lined by fibrous cartilage (rather than hyaline cartilage). The joint is surrounded by a capsule that is attached beyond the limits of the articular surfaces. The capsule is strengthened medially and laterally by collateral ligaments. Posteriorly it is attached to the anterior edge of the squamou-tympanic fissure.

Answer 31

Clear fluids for 24h prior to procedure

Answer 32

Sodium picosulphate (1 satchet BD) and clear fluids for 24h prior to procedure

Answer 33

Phosphate enema prior to procedure

Answer 34

Clear fluids for 24h prior to procedure. Stimulant laxatives would be hazardous due to obstruction

Answer 35

AD Multiple basal cell naevi on th skin with malignant changes arising during puberty Jaw cysts Pitting of the palm and soles

Answer 36

Not always the same as those in adults. Dark lobster red and slight mottling is indicative of deep partial or full-thickness burns and in a few days will usually become an opaque colour of an obviously deep burn

Answer 37

May be indicated in children with 10% total body surface area burn

Answer 38

Kallman's syndrome: hypothalamic gonadotrophin-releasing hormone deficiency and anosmia. X-linked or AR Gonadotrophin deficiency arises from a failure of embryonic migration of GnRH secreting neurones from their site of origin in the nose. Same defect affects the olfactory neurones resulting in olfactory bulb aplasia. More than half of patients have associated somatic stigmata, most commonly, nerve deafness , colour blindness, mid-line cranio-facial defomities e.g. cleft lip and palate and renal abdnormalities

Answer 39

Oestrogens or drugs with similar activity Drugs that enhance oestrogen synthesis Drusg that inhibit testosterone synthesis

Answer 40

Fibrous Cartilaginous (primary and secondary) Synovial (typical and atypical)

Answer 41

Formed when bone meets cartilage Immobile and very strong Adjacent bone may fracture but the bone-cartilage interface seldom separates. All epiphyses and ribs attaching to costal cartilages are examples

Answer 42

Unite the bones of the vault of the skull at the sutures. Movement negligible

Answer 43

Union between bones whose articular surfaces are covered with a thin lamina of hyaline cartilage which in turn is frequently united by fibrocartilage. All midline joints are secondary cartilaginous joints

Answer 44

Bone ends are covered by hyaline cartilage and surrounded by a capsule enclosing a joint cavity. Capsule is lined by synovial membrane and reinforced internally or externally by ligaments.

Answer 45

No hyaline cartilage The cartilaginous epiphysis has no blood supply.

Answer 46

Membranous canal 18mm long extending from lower part of the lacrimal sac to the inferior meatus of the nose Ends at the pica lacrimalis (Hasner's fold), formed by a fold of the mucous membrane. It is contained in an osseous canal formed by the maxilla, the lacrimal bone and the inferior nasal concha. It is narrower in the middle than at either end and is directed downwards, backwards and laterally. It is covered in columnar epithelium which is ciliated in palces

Answer 47

Very high risk surgical patient with critical ischaemia, not in patients with caludication

Answer 48

Aortobifemoral bypass

Answer 49

Median rhomboid glossitis

Answer 50

Geographical tongue

Answer 51

Hairy tongue

Answer 52

Likely to result in bony damage e.g. tibial plateau fracture. Similar force in a football match is likely to result in MCL injury.

Answer 53

Gluteus medius. Unopposed action of hip flexors causes proximal fragment flexion. Action of the gluteal muscles causes abduction and external rotation.

Answer 54

In the anatomical snuffbox from the dorsal venous plexus of the hand

Answer 55

Epiphysis Metaphysis Diaphysis

Answer 56

New bone formation once the cortex has been destroyed

Answer 57

Elevation of the periosteum by invasion of tumour through the cortex

Answer 58

Trauma can account for up to 47% of osteomyelitis cases

Answer 59

Risk of CBD injury is ~0.5% Mortality \<0.4% Risk of conversion to open 5% Risk of VTE without prophylaxis is 1-2%

Answer 60

Optic canal Ophthalmic is a branch of the ICA and enters the orbital cavity through the optic foramen below and lateral to the optic nerve. It then passes over the nerve to reach the medial wall of the orbit and thence horizontally foward, beneath the lower border of the SOF and divides into 2 terminal branches- frontal and dorsal nasal. As the artery crosses the optic nerve it is accompanied by the nasocilliary nerve and is separated from the frontal nerve by superior rectus and LPS

Answer 61

Patient supine, legs elevated to 45 degrees and held there for 1-2 minutes. Pallor indicates ischaemia and occurs when the arterial pressure is unable to overcome the effects of gravity. The poorer the arterial supply, the less the angle which the legs have to be rasied for them to become pale. The patient is then sat up and asked to dangle his legs down the side of the bed. Gravity causes the colour to return to ischaemic feet which become blue (deoxygenated blood) and then red (reactive hyperaemia from post-hypoxic vasodilation).

Answer 62

S wave in I, Q wave in III and T wave in III

Answer 63

Compensatory sweating

Answer 64

Partial/full thickness burns \>10% of TBSA in \<10 or \>50 Partial/full thickness burns \>20% of TBSA Partial/FTB involving face, ears, hands, feet, genitalia, perineum or skin overlying major joints. FTB \>5% Significant electrical burns including lightning Significant chemical burns Inhalation injury Burn injury in patients with pre-existing illness likely to affect mortality Any burn injury in context of concomitant trauma Burn injuries in patients requiring special social support including NAI. Children with burn injuries seen in hospitals without qualified personnel or equipment to manage their care

Answer 65

Small and abnormally shaped RBCs due to abnormal Hb causing destruction i.e. hypochromic microcytic

Answer 66

Thyrotoxicosis As others precluded by other test results

Answer 67

Nelson's syndrome Skin pigmentation caused by ACT levels that resembles MSH

Answer 68

Formed behind the first costal cartilage by the union of the right and left brachiocephalic veins. Ends behind the third costal cartilage as it enters the RA

Answer 69

Usually only occurs after 28 days of obstruction

Answer 70

Common bile duct runs anteriorly to the portal vein in the free edge of the lesser omentum

Answer 71

IgG and IgM

Answer 72

C3b and Bb

Answer 73

C4b and C2a

Answer 74

Fc rather than Fab

Answer 75

Clotting of blood can lead to complement activation and hence complement conversion products must be measured from plasma and not serum

Answer 76

Nulliparity increases the risk of breast cancer. Having a child at an early age is a protective factor against developing breast cancer. However, a woman who has had her first child in her mid to late thirties is at higher risk of breast cancer than a nulliparous woman. Breast cancer risk increases about 3% every year older a woman is when she first gives birth. It is thought that pregnancy reduces the susceptbility of mammary tissue to somatic mutations so conferring protection against breast cancer.

Answer 77

SCC bronchus

Answer 78

Pain is absent when patient awakens but appears mid-morning. It is relieved by food but recurs in 2-3h after a meal. Pain that awakens a patient at night is highly suggestive of duodenal ulcers. Duodenal ulcers are more common than gastric ulcers

Answer 79

Region of the mental foramen. Due to the deep socket of the canine tooth

Answer 80

Laceration to the buccal mucosa

Answer 81

Bacteria with capsules can only be removed via opsonisation. Spleen is pivotal in initiation of antibody response and the phagocytosis of opsonised encapsulated bacteria.

Answer 82

Pituitary disease Failure to suppress is suggestive of ectopic ACTH

Answer 83

Staph aureus

Answer 84

On day 37 (beginning of 6/52) a small sulcus forms above and below each eye known as the eyelid groove. As the groove deepens, eyelid folds develop into the eyelids and cover the eye. Closure of the eyelids is completed by the middle of 8/52. Upper lip is completed by 8/52 not the lower lip. External parts of the ear are distinguishable form week 6 of development. Palate is completed at 10/52

Answer 85

Hydrofluoric acid penetrates tissues deeply and even small burns can cause fatal systemic toxicity. Copious lavage with water and treatment with topical calcium gluconate gel is the necessary first step. Systemic calcium may be required as hydrofluoric acid sequesters Ca following the burn

Answer 86

Acid burns generally more painful. Alkali burns have delayed onset of pain. Alkali burns generally more serious

Answer 87

Should be brushed away before irrigation with water

Answer 88

Ischiorectal abscess that extends to both sides of the anal canal forming a horseshoe space

Answer 89

Form from an upward extension of an intersphincteric abscess into the supralevator space. May also from from an intra-abdominal inflammation tracking down

Answer 90

Hypoalbuminaemia Plasma cell dyscrasia Monoclonal protein Bromide intoxication Normal variant Loss of bicarbonate Recovery from DKA Ileostomy fluid loss Carbonic anhydrase inhibtors (acetazolamide, dorzolamide, topiramate) RTA Arginine and lysine in parenteral nutrition

Answer 91

Methanol Uraemia DKA Propylene glycol Isoniazid intoxication Lactic acidosis Ethanol ethylene gylcol Rhabdomyoloysis/renal failure

Answer 92

Uncomplicated inguinal hernia repair should not involve any mucosal breach. This wound is deemed clean with 2% risk of infection

Answer 93

Extensive spillage results in a greater than 40% risk of infection i.e. dirty operation

Answer 94

Uncomplicated appendicitis has a 10% risk of infection

Answer 95

Large bowel resection is likely to lead to some spillage of GI contents. Risk of infection ranges from 10-20%

Answer 96

Riased BP on two separate readings taken 6h apart and 300mg of protein in 24h urine sample

Answer 97

Greater auricular nerve (C2-C3)

Answer 98

Pain Pallor Pulselessness Paraesthesia Paralysis Perishingly cold

Answer 99

Dura has strong attachments to the crania along the suture lines and as a result these limit the extent of the haematoma

Answer 100

Palatoglossus- vagus

Answer 101

One of the geniculate arteries runs within the ligament

Answer 102

Chronic empyema results in thickening of the pleura and restricted chest movement, decreasing the space between the ribs-\> scoliosis. Restrictive pattern. Empyema is defined as a collection of purulent fluid in the pleural space and as such is within a pre-existing cavity. It is commonly basal rather than inter-lobular. Bronchopleural fistula is a relatively rare complication of empyema resulting from extension of the infection into the bronchus. The empyema can also fistulate to the skin and cause a condition called empyema necessitates

Answer 103

Indicates overfilling or a failing myocardium

Answer 104

Equivalent to 1L NS

Answer 105

May be seen in HIV infected patients. Presents with pain, tenderness and swelling with overlying skin being smooth and shiny, thereby mimicking an abscess

Answer 106

Dull facial expression Puffiness and periorbital swelling caused by infiltration with mucopolysaccharides Decreased adrenergic drive Lethargy Bradycardia Cold intolerance

Answer 107

Paralytic ileus and subsequent gastric dilation is common in burns \>20% although GI function typically returns to normal within 48h. Burn injuries result in decreased gastric acid production in the acute shock period. Curling's ulcers rather than Cushing's are stress ulcers related to major burns. They have a propensity to major bleeding and have a poor prognosis. Major burns are associated with splanchnic vasoconstriction. Terminal ileal lymphoid hyperplasia is a rare condition of no known aetilogy and with no relation to burns

Answer 108

Tend to shrink and are associated with abnormal pigmentation. Full thickness skin grafts resist contraction and have a potential for growth.

Answer 109

Split thickness- secondary intention Full thickness- primary closure

Answer 110

5-7mmHg and should be less than the pressure in the IVC by 5mmg. If the pressure difference- Hepatic venous pressure gradient is \>5 then portal HTN is diagnosed

Answer 111

Mucoepidermoid carcinoma is the most common malignant tumour of the parotid and the second most common malignancy of the submandibular and minor salivary glands (adenoid cystic is more common in these glands)

Answer 112

Tracheostomy bypasses the anatomical dead space above the level of the tracheostomy. Standing increases dead space.

Answer 113

SOF is at the apex of the orbit bounded primarily by the greater and lesser wings of sphenoid. The tendons of LR divide the SOF into superior and inferior parts. The trochlear, frontal and lacrimal nerves passs superiorly with the superior orbital vein. Superior and inferior branches of the oculomotor nerve, abducens and nasociliary nerves pass inferiorly with the orbital vein. Frontal and nasocliary nerves arise from the ophthalmic divison of trigeminal nerve in the lateral wall of the cavernous sinus. The zygomatic nerve is a branch of the maxillary division of the trigeminal nerve that enters the orbit through the inferior orbital fissure

Answer 114

Superior ophthalmic vein CN III, IV, VI V1

Answer 115

Maxillary nerve Zygomatic nerve Orbital branches of pterygopalatine ganglion Infraorbital vessels; inferior ophthalmic veins

Answer 116

Cystine and urate stones

Answer 117

35 days at 4 degrees

Answer 118

FFP and cryoprecipitate

Answer 119

Neer Classification Group

Answer 120

Axillary nerve and circumflex humeral vessles at the surgical neck. Radial nerve and profund brachii vessels at the surgical groove Ulnar nerve at the medial epicondyle

Answer 121

Might cause axillary nerve damage

Answer 122

Avascular necrosis

Answer 123

May result in painful arc syndrome

Answer 124

Usually asymptomatic Mesh repairs are rarely performed due to risk of infection around stoma site

Answer 125

Obesity Increasing age Post-op infection Malnutrition Site of stoma (i.e. outside of rectus)

Answer 126

Sensory inferior to the vocal folds

Answer 127

Myelosuppression Acute pancreatitis

Answer 128

NS should be used to supply sufficient chloride ions to replace those lost in the gastric fluid. If this is not done then metabolic alkalosis can ensue.

Answer 129

Should not be administered in patients at risk for alkalosis Lactate is metabolised to bicarbonate, administration may result in or worsen metabolic alkalosis, seizure may be precipitated by the alkalosis but this is uncommon

Answer 130

Thickening and development of a discrete tumour nodule

Answer 131

Smokers Xeroderma pigmentosa In previous RTx scars.

Answer 132

Roof of the orbits Sphenoid bone Parts of the temporal bone

Answer 133

Age \>55 WCC \>16 Glucose \>11 LDH \>350 AST \>250

Answer 134

HCt fall \>10% BUN increase \>1.8 Serum Ca \<2 PaO2 \<8 Base deficit \>4 Fluid sequestration \>6L

Answer 135

In the absence of IV contrast= Balthazar Ranson In presence = CT severity index

Answer 136

Open thoracotomy most appropriate option for management as this is an organised, multi-loculated empyema with a thick fibrous peel.

Answer 137

Pleural peel history of 4-6/52 Disabling respiratory symptoms Radiological evidence of trapped lung

Answer 138

Lateral cutaneous nerve of the forearm

Answer 139

Ambulatory pH monitoring

Answer 140

Cricopharyngeal sphincter Aortic arch Left principle bronchus Diaphragm

Answer 141

Supplies posterior nasal mucosa. Branch of the third part of the internal maxillary artery, passing through the sphenopalatine foramen into the cavity of the nose at the back of the superior meatus where it gives off its posterior lateral nasal branches which anastomose with the ethmoidal arteries and nasal branches of the descending palatine and assist in supplying the sinuses. Artery can be ligated in severe posterior posterior bleeds.

Answer 142

Anterior ethmoidal/posterior ethmoidal arteries Superior labial arteries Greater palatine artery Sphenopalatine artery

Answer 143

Rapid sodium influx

Answer 144

Efflux of K

Answer 145

Slow efflux of calcium

Answer 146

efflux of K

Answer 147

Sodium/calcium efflux, K influx

Answer 148

Testicular seminoma

Answer 149

Subaponeurotic scalp haematoma

Answer 150

Royal Marsden staging system

Answer 151

Confined to testis IM= rising concentrations of serum markes with no other evidence of mestastasis

Answer 152

Abdominal node metastases

Answer 153

\<2cm in diameter

Answer 154

2-5cm in diameter

Answer 155

Supradiaphragmatic node metastases

Answer 156

Node stage as defined in stage II

Answer 157

Mediastinal LNs

Answer 158

Supraclavicular, cervical or axillary nodes

Answer 159

No abdominal mets

Answer 160

Extralymphatic metastases

Answer 161

\<3 mets to lung

Answer 162

\>3 mets, all \<2cm in diameter

Answer 163

\>3 mets, one or more of which are \>2cm in diameter

Answer 164

Volume of stomach contents Composition of stomach conents

Answer 165

Increased PR and QTc Prolonged QTC complex Peaked T waves Flattened p waves Complete AV block and asystole can occur

Answer 166

Narrowing of QRS complex Reduced PR interval T wave flattening and inversion Prolongation of QT interval Prominent U wave Prolonged ST and ST depression

Answer 167

Grey platelet syndrome

Answer 168

Failure of megakaryocytes to package secretory proteins into alpha granules. Alpha granule contain a number of growth factors and other clotting proteins. Patients with GPS are affected by mild to moderate bleeding tendencies

Answer 169

Severe form of DVT affecting the major veins of one of the extremities as well as its collaterals

Answer 170

Pyogenic arthritis Muscle imbalance e.g. CP Trauma

Answer 171

Hip is flexed and adducted Posterior dislocation is the commonest direction Acetabular fracture may accompany hip dislocation in 50% of cases

Answer 172

Sciatic nerve injury Femoral head damage Avascular necrosis of the femoral head Post-traumatic ossification Osteoarthritis

Answer 173

Treatment is with the inhibitor which is present in FFP.

Answer 174

When GFR falls to \<15-10 Hyporeninaemic hypoaldosteronism ACEi K sparing diuretics Beta blockers NSAIDs

Answer 175

S1, S2 ankle L3, L4, knee C5, C6 biceps C7, C8 triceps

Answer 176

Dehydrataion and hypokalaemic hypochloraemic metabolic alkalosis Alkalosis is as a result of unbuffered hydrogen ions in gastric juice with concomitant retention of bicarbonate. Fluid loss stimulates renal Na reabsorption but sodium can only be reabsorbed either with chloride or in exchange for H and K ions to maintain electroneutrality. Gastric juice has a high concentration of chloride and patients losing gastric secretions become hypochloraemic. This means less sodium than normal can be reabsorbed with chloride. Defence of ECF volume takes presence over acid-base homeostasis and further Na reabsorption occurs in exchange for H ions (perpetuating the alkalosis) and K ions (leading to potassium depletion. This explains the apparently paradoxical findings of acidic urine in patients with py sten. K is also lost from the gastric juice.

Answer 177

50x higher

Answer 178

Prevents the femur from sliding forwards off the tibial plateau. In the weight bearing flexed knee it is the only stablising factor for the femur and the quadriceps. Patients with PCL rupture may experience difficulty walking down stairs

Answer 179

40ml H2O/kg/24h

Answer 180

Posterior: Iliolumbar Lateral sacral Gluteal (superior and inferior) Anterior: Pudendal Inferior vesical artery (uterine in females) Middle rectal Vaginal Obturator Umbilical artery

Answer 181

Inferior epigastric Deep circumflex iliac Common femoral artery

Answer 182

The liver It binds both T3 and T4

Answer 183

The two parts of the right atrium are separated externally by a groove on the posterior aspect of the atrium known as the sulcu terminalis and internally by the crista terminalis which extends between the two vena caval orifices. The fossa ovalis is found on the interatrial septum which forms the posteriomedial wall of the right atrium The opening of the coronary sinus is guarded by a semicircular valve that closes the orifice during right atrial contraction

Answer 184

Fat embolism

Answer 185

Individual with first-degree relative diagnosed with CRC \<55y/o has a 2-5x risk than of someone with no FHx of CRC.

Answer 186

Neuromyotonia Paraneoplastic syndrome associated wtih SCLC with neural autoantibodies to K channels Causes hyperexcitability and continuous firing of the peripheral nerve axons that activate muscle fibres

Answer 187

In men the deep perineal pouch contains the membranous urethra, sphincter urethra, bulbourethral glands, deep transverse perineal muscles, internal pudendal vessles and dorsal nerves of the penis. The bulb of the penis lies in the superficial perineal pouch

Answer 188

Have poor clearance rates and thus PCNL is the preferred option

Answer 189

Protein degradation

Answer 190

Intercrural fibres that run at right angles across the external oblique aponeurosis

Answer 191

Hypothalamic paraventricular and supraoptic nuclei

Answer 192

Enters through Guyon's canal on the superficial ulnar aspect of the wrist between the pisiform bone and the hook of the foreaarm

Answer 193

Change in vascular pressures lead to an influx of extra-cellular water into the circulation, a phenomenon known as transcapillary refilling

Answer 194

May occur from the production of hydrogen cyanide from burning plastics Rapidly absorbed through the lungs and binds readily to the cytochrome system, inhibiting cell function. Can result in LOC, neurotoxicity and convulsions. It is gradually metabolised by the liver enzyme rhodenase. Lethal levels are 1.0mg/litre Bicarbonate may be used in severe toxicity to neutralise lactic acidosis. Cyanide intoxication is often fatal because washout of cyanide from the blood while breathing oxygen at atmospheric pressure does not occur as effectively as for CO intoxication

Answer 195

Membrane potential at which there is no net flow of a specific ion across the membrane

Answer 196

LCIS- 10x risk

Answer 197

SCC in situ of the penis

Answer 198

20% risk of malignancy over 5y

Answer 199

70% secrete AFP 60% secrete beta HCG 90% screen for one or the other

Answer 200

A1 adrenoreceptor antagonist. Causes relaxation of the bladder neck and prostate capsule

Answer 201

Appears in the gluteal region below the lower border of piriformis muscle in the vast majority of cases

Answer 202

Aortic balloon pumps inflate during diastole, reducing afterload and increasing coronary artery perfusion. It deflates in systole, increasing forward blood flow by reducing afterload through a vacuum effect

Answer 203

Severe benign liver disease Inflammatory conditions of the GIT Trauma Infection Collagen diseases Renal impairment Smoking

Answer 204

Water-soluble glycoprotein

Answer 205

Inadequate blood supply Infection Incorrect immobilisation Intact fellow bone e.g. fibula in tibial fracture

Answer 206

Loop colostomy. Patients who have large tumours may be suitable for pre-operative Rtx to downsize lesion. They will require loop colostomy to divert the faecal stream, this is commonly performed at the transverse or sigmoid colon

Answer 207

Pituitary basophils (gonadotrophs) responsible for secreting LH

Answer 208

Should consider stopping oestrogen-containing oral contraceptives or HRT 4/52 before elective surgery.

Answer 209

50:50 mix of lignocaine and bupivacaine with the possibility of the addition of adrenaline 1:200000

Answer 210

Cervical branch of facial nerve

Answer 211

Collagenous Lymphocytic

Answer 212

Chronic watery diarrhoea Normal mucosa on colonoscopy Characteristic histological changes in the mucosal biopsy. When there is significant lymphocytic infiltration in the lamina propria the disease may be termed lymphocytic colitis. When there is fibrotic thickening of the subepithelial collagen layer, the disease is called collagenous colitis

Answer 213

?CMV colitis Can cause severe dirarhoea and torrential even life-threatning rectal bleeding.

Answer 214

Fibrothecoma is a benign ovarian tumour. The thecoma component gives the tumour a yellowish appearance because of thelipid content and can also produce oestrogen which is responsible for endometrial hyerplasia. They arise from the ovarian stroma and are bilateral in 10% of cases. A right sided hydrothorax in association with this tumour is known as Meig's syndrome

Answer 215

Papillary thyroid carcinoma

Answer 216

C3,4,5 Deep to scalenus anterior and medius muscles. Runs on scalenus anterior over the anterior part of the dome of te pleura to enter the mediastinum posterior to the subcalvian vein. Here the right phrenic nerve spirals forward to lie on the SVC, right atrium and IVC and transverses the diaphragm via the caval orifice

Answer 217

Hypertonic NaCl. Exerts effect on whole extracellular compartment, gelofusin will remain intravascular

Answer 218

Due to a reduction in sympathetic tone causing splanchnic vasodilation and venous pooling. It can managed with IVF or inotropes if refractory to fluid management

Answer 219

1-5% of cases

Answer 220

Alveolar damage due to the wall being subjected to high inflation pressures Pneumothorax VAP O2 toxicity ALI

Answer 221

Very rarely. Generally in patients with pre-existing liver pathology. IPPV-\> reduced venous return and preload leading to reduced CO. Results in proportional reduction in hepatic blood flow. Increased intrathoracic pressure also causes intrahepatic venous congestion and dysfunction in portal vein flow.

Answer 222

Increases ICP

Answer 223

Causes reduction in blood presssure because an increaed intrathoracic pressure increases RAP. THis event causes an impediment to venous return and a reduction in CO-\> reduced BP

Answer 224

HbA1c of 48mmol (6.5%)

Answer 225

Fasting plasma glucose \>7 Random plasma glucose \>11.1

Answer 226

Deep vein occlusion and reliant on superficial venous system. However the superficial system is under pressure of high flow from arterial system which leads to a painful oedematous white leg. if this progresses, all venous outflow is occluded leading to cerulea dolens

Answer 227

Detection of the typical appearance of subtotal villous atrophy on a small bowel biopsy is the hold standard

Answer 228

Contraindicated in pregancny

Answer 229

Semi-lunar or crescenteric

Answer 230

Supraspinatus tendonitis

Answer 231

Scapulohumeral view

Answer 232

R ventricle. Most anterior chamber of the heart and thus most likely to be injured in penetrating trauma to the chest

Answer 233

Galeazzi's

Answer 234

Secondary active transport with Na

Answer 235

Hypothyroidism Alcohol Liver disease Conditions associated with an increased reticulocyte count

Answer 236

Lateral Hardinge approach

Answer 237

Causes hyperchloraemic acidosis. Rise in chloride relative to sodium which results in greater amounts of HCl and thus acidosis

Answer 238

Non parametric data Observations classified into mutually exclusive classes and the null hypothesis gives the probability that an observation falls into the corrseponding classes

Answer 239

Non-parametric data Used for comapring two or more independent samples of equal or different sizes

Answer 240

Non-parametric To compare two sample means from the same population Can be used as an alternative to the t-test when data are not normally distributed

Answer 241

Used for parametric data and aims to understand if there is an interaction between the two independent variables on the dependent variable

Answer 242

Patients with persistent symptoms and \>30% pancreatic necrosis and those with smaller areas of necrosis and clinical suspicion of sespis.

Answer 243

?ERCP and sphincterotomy

Answer 244

Circumoral skin, buccal mucosa, hands genitalia

Answer 245

Desquamation lesions of the skin and GIT (inflammation, bleeding, ulceration) Infertility BM suppression-\> BM failure

Answer 246

Facial weakness if usually present but resolves with time to affect \<20%

Answer 247

Inguinal hernia containing inflamed appendix

Answer 248

Adequate drainage Pressure dressings Serial aspirations Nutritional modfifications- medium chain triglycerides which are absorbed directly into the portal system bypassing the lymphatics

Answer 249

Fluid movement= Net filtration pressure minus net oncotic pressure

Answer 250

Have no malignant potential themselves but are associated with increased risk of other malignant gut polyps

Answer 251

Ulcer on the pinna may represent a skin malignancy

Answer 252

Killian's dehiscence between thyropharyngeal and cricopharyngeal muscles

Answer 253

Progesterone increases the sensitivity of hypothalamic respiratory centres to small increases in PCO2 and lowers the set point. A small rise in pCO2 results in increased ventilation of 6L/min, Normal pCO2 falls from 40-32 during pregnancy

Answer 254

5-15% of patients

Answer 255

Dejerine-Roussy Syndrome

Answer 256

LPL enzyme: features in this vignette are suggestive of hyperTG secondary to LPL deficiency. LPL deficiency leads to hypertriglyceridaemia LDLR disorders result in familial hypercholesterolaemia. Apo B100 mutations are associated with familial hypercholesterolaemia ApoB 48 mutations may affect chylomicron levles but wouldn't cause the hyperTG HMG-CoA mutations would lead to reduced cholesterol levels

Answer 257

Fluid administration should maintain a UO of at least 100ml/h

Answer 258

If cardiac injury is diagnosed, monitoring is not indicated if echo is normal and there was no history of LOC

Answer 259

Bronchoalveolar carcinoma

Answer 260

Weakness of the angle of the mouth due to potential facial nerve injury Other structures to be avoided at submandibular gland excision: mandibular branch of VII, hypoglossal and lingual nerves, facial artery and retromandibular vein

Answer 261

Lateral pteryogid

Answer 262

Biofeedback

Answer 263

4% formalin topically Other options include YAG laser and surgery in the form of a coloanal sleeve anastomosis

Answer 264

Management of infected and exuding wounds, particularly diabetic foot ulcers

Answer 265

Area of the pericardial cavity located behind the aorta and the pulmonary trunk and anterior to the SVC

Answer 266

\<10% All cases of microscopic haematuria should be investigated

Answer 267

Posterior descending coronary artery

Answer 268

Haemolysins Fibrinolysin Hyaluronidase Leucocidin Coagulase Enterotoxin TSST Epidermolytic toxin

Answer 269

Long cystic duct travelling alongside the common hepatic duct GB opening directly into the side of the CBD i.e. cystic duct is absent Variation in blood vessel arragnement supplying the GB e.g. Right hepatic artery crossing in front of the common hepatic duct instead of behind it

Answer 270

Function of \<15%

Answer 271

Polyhydramnios

Answer 272

Hypoalbuminaemia Other causes include hypercalcaemia, hypermagnesaemia, Li intoxiciation, hypergammalgobulinaemia Hyperviscosity or halide intoxication Effect of albumin can be accounted for by adjusting the anon gap 2.5mmol/l for every 10g/l fall in albumin

Answer 273

Via the lienorenal ligament

Answer 274

Contusion or non-expanding subscapular haematoma No laceration

Answer 275

Non-expanding perirenal haematoma Cortical laceration \<1cm deep without extravasation

Answer 276

Cortical laceration \>1cm without urinary extravasation

Answer 277

Laceration through corticomedullary junction into collecting system or Vascular segmental renal artery or vein with contained haematoma

Answer 278

Shattered kidney or Renal pedicle injury or avulsion

Answer 279

Tibial nerve

Answer 280

Completion total thyroidectomy There is no evidence to support radical block dissection of the neck for cases of localised papillary thyroid cancer

Answer 281

Hypofibrinogenaemia TCT used to assess fibrin formation. Prolonged TT is due to either fibrin abnormalities, impairment of formation or due to inhibition of thrombin e.g. heparin

Answer 282

Formed from the posterior divisions of all three trunks. Axillary nerve and radial nerve are the terminal branches

Answer 283

Thyroglossal cysts Neoplasms Pharyngeal pouches Plunging ranulae Subhyoid bursae Laryngoceles Lesions in the thyroid isthmus

Answer 284

Exogenous GC administration Endogenous: Pituitary adenoma producing excess ACTH Adrenal cortical adneoma/carcinoma Ectopic ACTH production

Answer 285

Overnight DMST 24h urinary free cortisol 48h dexamethasone suppression test Circadian rhythm of cortisol secretion

Answer 286

20-30% of patients with ARF who are haemodialysed become hypotensive with huge associated osmotic shifts- disequilibrium syndrome. Many ICU patients are intolerant of such shifts. Moreover, the haemodynamic changes that occur i.e. hypotension may worsen the pre-existing renal injury by increasing the ischaemic insult

Answer 287

5 years Liver

Answer 288

Boutonniere deformity

Answer 289

DIP flexion PIP hyperextension

Answer 290

Acts more or less as a pure vasoconstrictor and often results in a reflex bradycardia

Answer 291

15% Posterior interventricular artery is usually a branch of the RCA

Answer 292

Deep capillary naevus aka. Port-wine stain

Answer 293

With intracranial vascular malformations- Sturge Weber syndrome Congenital glaucoma if lesion occurs in the ophthalmic division Hypertrophy of underlying tissues e.g. the limb causing abnormal growth known as haemangiectatic hypertrophy

Answer 294

Pigmented lesion that consists of excess melanocytes in a normal position. E.g. Buccal lesions in Peutz-Jeghers

Answer 295

Strawberry naevus

Answer 296

Anti-Xa assay

Answer 297

During the first year 15% of grafts occlude Between 1 and 2% per year 4% per year from years 6-10 By 10 years post-op only 60% are patent and only 50% are free of significant stenosis

Answer 298

EPB and Abd PL

Answer 299

ECRL, ECRB

Answer 300

Dorsal tubercle of the radius aka Lister's tubercle

Answer 301

Pituitary normally located within the sella turcica and empty-sella syndrome occurs when the pituitary gland shrinks or becomes flattened meaning it cannot be seen on an MRI scan. The sella is often filled with CSF In most cases there are no symptoms or loss of pituitary function

Answer 302

Diffuse form of scleroderma can be associated with hyperplastic arteriosclerosis and malignant HTN

Answer 303

End-stage kidney

Answer 304

Minimal-change disease

Answer 305

Nerve loops around the remnant of the ductus arteriosus on the left, passing below the arch of the aorta whereas it passes below the subclavian artery on the right. This makes it susceptible to left hilar pathologies as it is more closely related to the left lung hilum

Answer 306

Aortic arch and junction of the azygos vein and SVC

Answer 307

Excessive crystalloid administration is associated wsith ARDS The increase in filtration pressure and decreased oncotic pressure promote increased alveolar capillary permeability

Answer 308

?Actue hepatitis

Answer 309

Chronic hepatitis

Answer 310

Faecal oral Water borne and food-borne epidemics occur Eating contaminated raw shellfish is sometimes responsible

Answer 311

Hyperkalaemia and hyperuricaemia (due to decreased excretion), hyponatraemia (due to continued water intake with decreased ability to excrete it) and metabolic acidosis occur in both acute and chronic renal failure. Presence of hypocalcaemia is more suggestive of longstanding disease and is due to reduced renal synthesis of calcitriol

Answer 312

\<5 days from donation

Answer 313

Promotes callus and is not a cause of delayed fracture union

Answer 314

Common peroneal part of sciatic nerve

Answer 315

Sural nerve

Answer 316

Occurs when a wound is closed within 12-24h of its creation as in a clean surgical incision or a clean laceration

Answer 317

Duodenal ulcers are more common than gastric ulcers

Answer 318

Integral to the production of prostaglandins that stimulate mucous secretion from the stoamch. Mucous protects the stomach from gastric acid.

Answer 319

Patient has SBO 2o to gallstone ileus. This is a surgical emergency requiring laparotomy. The gallstone usually impacts proximal to the ileocaecal valve and so should be massaged through the large intestine or extracted via a proximal enterotomy thus relieving the obstruction. The gallstone will have passed into the small bowel throug a biliary-enteric fistula but this does not usually require surgical repair. Such fistulae often lead to aerobilia which can be seen on AXR

Answer 320

Posterior cricoarytenoid is innervated by the inferior laryngeal nerve which is a continuation of the RLN. It is is the only muscle that abducts the vocal folds. If the muscle is denervated, the vocal folds may be paralysed in an adducted position preventing air from entering the trachea

Answer 321

Phyllodes tumour. Up to 25% of the benign tumours undergo malignant transformation

Answer 322

Neonates Patients with impaired function Patients with suspected obstruction Due to its more efficient extraction

Answer 323

It is not possible to store bicarbonate in a solution that contains Ca. Instead lactate is used which is metabolised to bicarbonate by the liver

Answer 324

3:1 replacement rule i.e. 300 cc of crystalloid is required to compensate for each 100cc of blood lost

Answer 325

Children have a relatively larger head which tends to flex the head on the neck making obstruction more likely. The relatively larger tongue in children tends to flop back and obstruct the airway in the obtunded child, which means that there is less room in the mouth for intubation. The larynx is more cephallically positioned in children. The trachea is shorter The narrowest point of a child's airway is the cricoid ring whereas in adults it is the glottis

Answer 326

Unconjugated and as such does not appear in the urine.

Answer 327

Proteus Klebsiella Pseudomonas Enterobacter

Answer 328

Increased capillary permeability Interstitial and alveolar oedema Fibrin exudation Hyaline membrane formation later Diffuse late interstitial and alveolar fibrosis

Answer 329

Portal vein thrombosis

Answer 330

Tricspid incompetence Budd-Chiari- hepatic vein thrombosis

Answer 331

Stable fracture with impaction in valgus

Answer 332

Complete but non-displaced femoral neck #

Answer 333

Paritially displcaed (often externally rotated and angulated) with varus displacement but still has some contact between the two fragments

Answer 334

Completely dispalced and there is no contact between the fracture fragments

Answer 335

Hirschprung's disease Due to dilatation of the proximal ganlgionic oclon and the failure of the distal aganglionic part to distend

Answer 336

Superficial inguinal pouch (most common) Base of penis Perineum Femoral region

Answer 337

Smoking Genetics High intake of fat, oil and milk Exposure to toxins such as Pb, cadmium ,asbestos and petroleum products

Answer 338

Neuroblastoma often crosses the midline which is in contrast to nephroblastoma.

Answer 339

Barium follow-through

Answer 340

Usually oestrogen positive, HER negative and negative for expression of e-cadherin

Answer 341

Formed at the level of the right renal vein (either as a posterior tributary of the IVC) or as a confluence of the ascending lumbar vein and right subcostal. Passes through the diapghragm via the aortic opening at T12 and ascends on the right side of the vertebral bodies, posterior to the oesophagus. Terminates by arching over the hilum of the right lung to enter the SVC at the T4 level

Answer 342

Drain into the right superior intercostal vein which itself drains into the azygos vein. Other tributaries include the lower right posterior intercostal veins, bronchial and oesophageal veins and the 2 hemiazygos veins

Answer 343

84% of all neuroglial neoplasms Occurs predominantly in children with the greatest incidence in children aged 5-9 y/o

Answer 344

The cerebellar vermis ?from microscopic remnants of the cerebellar external granular layer

Answer 345

Anatomical dead space increases when lung volumes increase. Pain causes shallower breathing and decreases the anatomical dead space

Answer 346

Rare complication of sinusitis characterised by subperiosteal abscess and osteomyelitis related to the frontal sinus and sometimes also the mastoid. The patient will have a swelling of the forehead. Most common pathogens are strep and staph and anaerobes that colonised the RUI. Imaging with CT or MRI and treatment with surgical drainage and IV abx

Answer 347

WHO ladder NSAIDs can have excelllent additive effect. Steroids can reduce swelling, inflammation and pain, with dexamethasone being the drug of choice

Answer 348

Grow centripetally Respect fascial boundaries and remain confined in the compartment of origin until late stages of disease . Local neurovascular structures are usually compressed rather than invaded.

Answer 349

JG cells Macula densa Lacis cells

Answer 350

In flame burns, all clothing and jewellery should be removed as soon as possible. Skin that is adherent and peels off with clothing is non-viable and it is essential to remove all dead tissue

Answer 351

Helps to decompress the stomach and ensures mucosal integrity, minimising the risk of endogenous infection and bacterial translocation

Answer 352

Voluntary muscle Innervated by the somatic inferior rectal nerves, originating from the pudendal nerves

Answer 353

Involuntary and is innervated by post-ganglionic parasympathetic fibres

Answer 354

Can rarely produce ectopic ACTH

Answer 355

Drug that affects the rate of relaxation of the heart

Answer 356

Papillary thyroid carcinoma

Answer 357

Flex the MCPJs and extend the IPJs

Answer 358

When the ulnar nerve is transected at the wrist, power is lost to the lubmicrals of the little and ring finger as well as the other intrinsic muscles of the hand, leading to unopposed extension at the MCPJs (lumbricals flex the MCPJs and extend the IPJs) If the lesion is at the level of the wrist, the power to the ulnar half of FDP is preserved and the IPJs are therefore flexed, leading to claw hand appearance of extended MCPJs and flexed IPJs in the ring and little fingers. If the nerve is transected at the elbow, power to the ulnar half of FDP is also lost, leading to less flexion at the IPJs and therefore a less deformed but less functional hand

Answer 359

Lower subscapular Subscapularis originates in the subscapular fossa and inserts into the lesser tubercle of the humerus (only muscle to do so)

Answer 360

70% arise in the peripheral zone 20% in the transitional zone 10% in the cenral zone

Answer 361

Important health problem Accepted treatment Facilities for dx and treatment must be available Latent stage Screening test should have high sensitivity and specificity The test should be acceptable to the population Natural history of the disease should be adequately understood. There should be an agreed policy on which patients should be treated. Dx and treatment should be relatively cost-effective. Screening should be an ongoing process

Answer 362

Ca Citrate or EDTA is used as anticoagulants in blood sample bottles as they chelate calcium to stop clotting from occuring

Answer 363

The first rib is related to the lower two roots of the brachial plexus, C8 and T1 The cervicothoracic ganglion, otherwise known as the stellate ganglion, lies in front of the neck of the first rib

Answer 364

Most likely to be caused by a hiatus hernia. Pharyngeal pouches are more commonly seen in the elderly

Answer 365

Viral (mumps) Acute bacterial parotitis can occur, particularly in neonates and the elderly and debilitated. Poor oral hygiene and dehydration are risk factors. Commonest bacterial cause is staph aureus

Answer 366

Osteosarcoma

Answer 367

Synergistic risk factors increasing the risk x6

Answer 368

Suture both testes to the midline with non-absorbable sutures leaving them invaginated in the tunica vaginalis

Answer 369

Morton's metatarsalgia

Answer 370

Thought to occur following entrapment of a digital nerve between the metatarsal heads with thickening and formation of a neuroma. The nerve most commonly affected lies between the third and fourth metatarsal heads.

Answer 371

Hammertoe Pain occuring as a result of callosities forming over pressure areas

Answer 372

Sever's disease

Answer 373

Sever's disease

Answer 374

Antithrombin II deficiency

Answer 375

L1 Surface marking mid-way between the suprasternal notch and the pubic symphysis

Answer 376

CT myelogram

Answer 377

Asymptomatic DVT which occurs in 50% of cases despite prophylaxis but rarely progresses to PE Heterotopic ossification affects 10% of cases Dislocation occurs in 2-5% Retention is a problem, especially in elderly men

Answer 378

Alkylating agent activated by microsomal enzymes of the liver.

Answer 379

4-hydroxycyclophosphamide

Answer 380

Less myelotoxic, equally effective

Answer 381

Transverse "unilateral" Pfannsteil which can be extended to complete Pfannsteil if formal laparotomy required

Answer 382

Upper midline

Answer 383

Fascial tunnel on the lateral wall of the ischiorectal fossa which conveys the pudendal nerve and vessels.

Answer 384

Accessory pancreatic duct

Answer 385

Fistulotomy as it only encircles a proportion of the internal sphincter muscles which when laid open are unlikely to result in significant continence disturbance

Answer 386

Milligan and Morgan's sharp excision and stapled haemorrhoidectomy

Answer 387

50% Overall mortality is 75%

Answer 388

Patients are unable to inactivate the active forms of the procoagulant factors Va and VIIIa

Answer 389

Binds with antithrombin which in turn accelerates the inhibition of factor Xa

Answer 390

Vascular endothelium

Answer 391

PUJ VUJ Where the iliac vessels cross it

Answer 392

Generation of glucose from non carbohydrate sources

Answer 393

Transversalis fascia

Answer 394

Increased vascular permeability Bronchoconstriction Chemotaxis

Answer 395

Via the dorsal carpal branch of the radial artery with some contribution from the superficial palmar branch of the radial artery on the palmar surface. Both of these arteries supply the distal pole and the proximal pole via retrograde interosseous perforators

Answer 396

Elevation Rest NSAIDs Abx

Answer 397

Totally extraperitoneal repair

Answer 398

Lichenstein mesh or shouldice repair or totally extra-peritoneal repair Current favoured method is the TEP repair as it has equivalent recurrence rates to Lichtenstein repair and return to work is quicker

Answer 399

Increase in vertical dimension of the chest on inspiration Upwards and outwards movement of the ribs Rise and fall of the hemidiaphragms Serratus anterior is involved in respiration Note first rib does not move during respiration

Answer 400

Pelvic splanchnic nerves

Answer 401

The end of the transverse colon

Answer 402

Joins the yolk sac to the primitive embryo. Persistence= Meckel's diverticulum

Answer 403

The process by which genetic errors are corrected. DNA polymerases may have 3-\>5 exonuclease activity that can replace miscinorporated nucleotides

Answer 404

Proximal- line connecting the medial and lateral epicondyles of the humerus Medially- pronator teres Laterally- brachioradialis Roof: bicipital aponeurosis, antebrachial and brachial fascia, subcutaneous fat and skin Floor: brachialis and supinator muscles

Answer 405

Radial nerve Biceps Tendon Brachial Artery Median Nerve

Answer 406

Dysphasia/problems with speech.

Answer 407

85% of chemotherapy associated infections are caused by commensal organisms from the GIT and oral cavity

Answer 408

Potential life-threatening GI complication of CTx associated with nausea, vomiting, abdominal distension, fever, chills and pain

Answer 409

Epithelium of the GIT and its associated glands as well as glandular cells of the liver and pancreas, epithelium of the urachus, urinary bladder, epithelium of respiratory passages, epithelial parts of the tonsils, parathyroids, tympanic cavity and thymus and epithelial parts of the anterior pituitary

Answer 410

Posterior tibial tendon Static support of the ligaments and capsule (including the calcaneonavicular- spring ligament)

Answer 411

Used for mid-to long-term tracheobronchial toilet in those patients not requiring invasive ventilatory support

Answer 412

Infront of the aorta and inferior to the SMA

Answer 413

Each of the the three holes has three structures passing through them

Answer 414

T8 IVC Lymphatics Right phrenic nerve (left phrenic nerve pierces the diaphragm separately)

Answer 415

Oesophagus Vagal trunks Left gastric vessels

Answer 416

Aorta Thoracic duct Azygos vein

Answer 417

1% 90% of stones entering the intestine will impact in the terminal ileum