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MRCS Part A > Block 12 > Flashcards

Block 12 Flashcards

1
Q

What proportion of Crohn’s disease is ileocaecal?

A

It is the commonest site- 50%

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2
Q

String sign of Kantor

A

RIF string like strictures on barium studies

Crohn’s disease

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3
Q

SCLC

Bowel obstruction

A

Pseudo-obstruction

Autoimmune inflammation/destruction of the myenteric plexus

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4
Q

Which gender is most commonly affected in Hirschprung’s?

A

M:F

5:1

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5
Q

Pathophysiology of Hirschprung’s disease?

A

Defective neural crest cell migration resulting in a congenital absence of the ganglia that make up the Auerbach (myenteric) and Meissner (submucosal) plexus.

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6
Q

Biopsy in Hirschprung’s

A

Suction biopsy of the narrowed segment

Full-thickness rectal biopsy is required if suction biopsy is inconclusive

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7
Q

Pain on passive plantar flexion of the big toe but not on passive dorsiflexion

A

Compartment syndrome of the anterior compartment of the leg.

EHL is the muscle being stretched. This muscle is in the anterior compartment

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8
Q

What is the normal location of the major duodenal papilla

A

Descending part of the duodenum (i.e. the site where the CBD and pancreatic duct join and enter the duodenum)

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9
Q

Which of the following statements is true regarding familial hypocalciuric hypercalcaemia?

Hypermagnesaemia may be seen

It is AR

It is associated with increased urinary Ca excretion

It is associated with low PTH levels.

The condition responds to parathyroidectomy.

A

AD condition which is associated with decreased Urinary Ca excretion (<200mg/24h).

No response to parathyroidectomy

Hypermagnesaemia may be seen.

PTH levels are normal or slightly elevated

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10
Q

During repair of spaghetti wrist, what is the maximum torniquet time you should use?

A

Muscle tolerates an ischaemia time of approximately 6 hours, however in prolonged operations, surgeons will reduce the tourniquet every 2 hours for a period of 15 minutes to establish muscle perfusion

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11
Q

The tendons of which of the following muscles of the forearm is most vulnerable to damage in a laceration on the central palmar aspect of the rist?

FCR

FPL

Abductor PL

Supinator

FCU

A

FCR is one of the five superficial muscles of the flexor compartment of the forearm, it arises from the medial epicondyle and inserts radial to the carpal tunnel. It would be at risk from a palmar wrist laceration.

Abductor pollucis longus is on the dorsal aspect of the hand

FPL is in the deep compartment

Supinator is in the deep posterior compartment.

FCU sits on the most ulnar aspect of the wrist and as such is less at risk from a central laceration

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12
Q

At what MAP does CBF reduce?

A

MAP of <60.

This does not occur until there is a loss of over 40% of the circulating volume in a normal individual

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13
Q

When is eschar seen in burns?

A

Full thickness burns

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14
Q

Relationship between axillary clearance and survival in breast Ca

A

It yields prognostic information but there is no evidence that axillary clearance in itself prolongs survival

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15
Q

Which of the following statements regarding the mechanism of fetal wound healing is correct.

Reduced inflammatory response

Decreased synthesis of total collagen

Involves a decreased expression of transforming growth factor b3

Involves a reduction in migration of fibroblasts

Involves decrease in hyaluronic acid synthesis

A

Fetal wounds have reduced pro-inflammatory signals and there is thus a reduction in the inflammatory infiltrate during the early phase of healing

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16
Q

Jefferson fracture

A

Blow out fracture of the atlas caused by axial loading.

Best visualised with a peg view on plain radiography.

Unstable injuries requiring careful specialist spinal input

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17
Q

Hangman’s fracture

A

Bilateral fracture of the pars interarticularis affecting axis

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18
Q

By what rate does tamoxifen increase the risk of endometrial carcinoma?

A

From 1:1000 to 1:50

Hence it is second line in the hormonal treatment of breast cancer in post-menopausal women

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19
Q

What proportion of tumours in post-menopausal women are ER +ve?

A

2/3rds

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20
Q

Presentation of medullary thyroid cancer?

A

Thyroid mass or local lymphadenopathy

May present with diarrhoea due to calcitonin but occasionally with other paraneoplastic manifestations e.g. ectopic ACTH production

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21
Q

Failure rates of surgery in testicular germ cell tumours

A

Surgery alone: 20%

3% when Sx in combination with RTx

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22
Q

Adenocarcinoma and radiation

A

Most adenocracinomas are RTx insensitive

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23
Q

What is the ebb phase?

A

Seen in the first few hours of a traumatic insult to the body.

Decreased O2 consumption

Lactic acidosis

Increased stress hormone levels

Decreased insulin levles

Hyperglycaemia

Insulin resistance

Increased substrate consumption

Immune activation

Hepatic acute-phase response.

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24
Q

What is the flow phase

A

Days to weeks post trauma

Increased body temeprature

Increased O2 consumption

Negative nitrogen balance

Increased stress hormone levels

Hyperglycaemia

Gluconeogenesis

Lipolysis

Immunosuppresssion

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25
Q

Into what segment of the lung is an aspirated object likely to land?

A

Superior segmental bronchus of the right inferior lobe

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26
Q

What hormonal analogues are used in the treatment of prostatic carcinoma?

A

Goserelin and buserelin- GnRH analogues

Should be taken in combination with an anti-androgen i.e. bicalutamide intitially to mitigate effects of tumour flare through increased stimulate

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27
Q

Rate of myocardial blood flow at rest?

A

250ml/min

5% of CO

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28
Q

Right coronary artery supplies what proportion of left ventricular blood?

A

1/3

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29
Q

In what direction does sigmoid volvulus occur?

A

Anti-clockwise

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30
Q

What is the main branch of the posterior tibial artery?

A

Peroneal artery

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31
Q

Para-oesophageal hernia

A

Occur when part of the stomach herniates through the oesophageal hiatus to lie next to the OG junction without herniation of the junction.

The more common sliding hiatus hernia occur when the oesophagogastric junction herniates through the hiatus

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32
Q

How does para-oesphogeal hernia cause palpitations?

A

Through pressure on the vagus nerve.

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33
Q

Action of aldosterone

A

Na and H2O conservation

K loss

In distal tubule

Also promotes secretion of H ions, thereby regulating plasma bicarb levels

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34
Q

Cope sign

A

Pain on flexion and internal rotation of the hip causing pain if the appendix if in close relation to obturator internus

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35
Q

Psoas sign

A

Hip extension causing RIF pain in retrocaecal appendix

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36
Q

Gray

A

Unit of radiation dose absorbed per unit mass

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37
Q

Granuloma is seen in which of the following?

Syphillis

Typhoid

Cholera

Ameobiasis

Shigellosis

A

Tertiary syphillis

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38
Q

Diffusion capacity in restrictive lung disorders?

A

Characteristically decreased

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39
Q

FEV1/FVC in restrictive disorders

A

Normal

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40
Q

TLC in restrictive lung disease?

A

Reduced

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41
Q

Location of the SFJ?

A

1-4cm inferolateral to the pubic tubercle

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42
Q

Ludwig’s angina

A

Cellulitis affecting the submental spaces bilaterally

Usually dental in origin

Results in a raised hard floor of mouth

Trsimus is always present and the patient is systemically unwell.

Early diagnosis is esssential due to risk of airway compromise

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43
Q

Where is the proton pump found on gastric parietal cell?

A

Apical membrane (luminal) and excretes H into the lumen of the stomach in exchange for K ions

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44
Q

Urine in chronic metabolic alkalosis

A

The urine may become acidic, not alkalotic as a result of increased proximal renal tubular bicarbonate resorption (a consequence of hypochloraemia)

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45
Q

Berry’s ligament

A

Connects the thyroid to the cricoid cartilage and upper trachea

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46
Q

Which of the parathyroid glands are in a more constant anatomical position?

A

Superior parathyroid glands.

Inferior glands undergo further embryological migration.

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47
Q

Which of the thyroid veins is the least constant?

A

Middle thyroid veins

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48
Q

Indications for CABG

A

Stable angina, symptomatic control but angiography shows evidence of LMS or proximal triple vessel disease.

Stable angina with suitable coronaries and symptoms not adequately controlled by optimised medical therapy and for whom PCI is not appropriate

Unstable angina not controlled with medications and PCI is not approrpiate

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49
Q

Indications for CABG

STUD

A

Stenosis of LMS

Triple vessel disease

Unstable angina

Depressed ventricular function

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50
Q

Use of angioplasty in coronary artery disease

A

Reserved for patients with single or double vessel disease or patients with triple vessel disease who would not be fit for cardipulmonary bypass operation

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51
Q

Distal passage of the radial artery

A

Crosses the floor of the anatomical snuffbox before piercing the first dorsal interosseous muscle to form the deep palmar arch.

It gives off its dorsal carpal branch in the proximal part of the snuffbox

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52
Q

Superficial palmar arch is the direct continuation of the

A

Ulnar artery

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53
Q

Most common site for laryngeal malignancy?

A

Vocal cords

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54
Q

Anterior relations of the lesser sac

A

Visceral peritoneum along the posterior stomach

Lesser omentum

Gastrocolic omentum

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55
Q

Lateral border of the lesser omentum

A

Formed by the gastrosplenic ligament

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56
Q

Limitations on the application of tourniquets

A

Should not be applied for >1.5h and the pressure should not exceed 300mmHg.

Most common effect on peripheral nerves is neuropraxia

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57
Q

Mechanical effects of compression ischaemia on nerves caused by tourniquets?

A

Focal demyelination

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58
Q

Branchial cysts and airway

A

May enlarge periodically due to infection but are not associated with airway difficulty.

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59
Q

Normal volume of saliva production?

A

1-2L per day

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60
Q

Perinephric abscess following an episode of severe pyelonephritis.

Which of the following structures is not likely to be in contact with the purulent exudates?

Cisterna chlyi

Costodiaphragmatic angle of the pleural cavity.

Ilioingunial nerve

Psoas muscle

Subcostal nerve.

A

Kidneys are retroperitoneal.

Mostly covered by the costal margin.

Both kidneys are in contact with the costodiaphragamtic recess, psoas muscle, subcostal and ilioinguinal nerves.

The cisterna chyli is found on the right of the aorta and lies between the aorta and kidneys without direct contact

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61
Q

Stimulators of GH secretion?

A

Sleep

Exercise

Hypoglycaemia

Dietary protein

Estradiol

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62
Q

CSF rhinorrhoea in Le Fort fractures

A

More commonly seen in Le Fort III

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63
Q

Bilateral buttock and leg pain, worse when standing and walking.

Better with leaning forward.

Normal findings on examination

A

Spinal stenosis

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64
Q

Spinal stenosis

A

Due to narrowing of the spinal canal by either bony or soft tissue structures.

Patients present with neurogenic claudication.

MRI is the best investigation.

It is important to differentitate between neurogenic and vascular claudication

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65
Q

Hormonal therapy in endometrial caricnoma

A

Progestins are used

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66
Q

What is the most important factor in postoperative prosthetic function in a below knee amputation

A

Tibia should be divided approximately 15cm below the knee joint (at least 8cm is required) to fit a below knee prosthesis

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67
Q

Mortality in below knee amputation

A

10%

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68
Q

Mortality in above knee amputation

A

20-40%

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69
Q

Management of nerves in below knee amputation

A

Nerves are best cut cleanly under tension with a blade to reduce the incidence of neuroma.

Some surgeons insert one end of an epidural catheter into the sheath of the tibial nerve and bring out the other end through the skin.

LA can be run through this catheter to aid post-operative anaglesia and is said to help in the diminution of phantom pain

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70
Q

Classification of secondary osteoporosis

A

Nutritional

Endocrine

Drug related

Malignant

Systemic disease

Idiopathic

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71
Q

Origination of the hepatic portal vein

A

Posterior to the neck of the pancreas

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72
Q

Most common cause of surgical hypertension

A

Renovascular disease

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73
Q

Tumours most commonly metastasizing to the adrenal glands?

A

Lung and breast cancer

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74
Q

Pancreas tumours commonly metastasize to the

A

Liver

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75
Q

Procedure specific complications to TURP

A

Bladder perforation

ED

Incontinence

Haematuria

Retrograde ejaculation

UTI

Urethral stricture

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76
Q

Which of the following regarding the uterus is true?

Uterine wall consists of two layers, the myometrium and endometrium

Uterus is frequently retroverted in older women

Body of the uterus is enclosed between the layers of the round ligament

Principal support of the uterus is the uterosacral ligament

Peritoneum covers only the superior aspect of the uterus

A

Uterus is normally anteverted, however it is commonly retroverted in older women.

Wall consists of the perimetrium, myometrium, endometrium.

Body of the uterus is enclosed within the broad ligament.

Uterus is covered by peritoneum anteriorly and superiorly.

Principal support is the pelvic floor

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77
Q

Sterilisation of surgical materials

A

Autoclave

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78
Q

Sterilisation of endoscopes

A

Glutaraldehyde (disinfection)

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79
Q

Sterilisation of suture materials

A

Ethylene oxide

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80
Q

Sterilisation of surgical drapes?

A

Autoclave

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81
Q

Sterilisation of urinary catheters?

A

Ionising radiation

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82
Q

Lymphatic drainage of the cervix

A

External iliac nodes

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83
Q

Lymphatic drainage of the rectum

A

Para-aortic nodes

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84
Q

Definitive airway

A

Tube in the trachea with cuff inflated, connected to a form of oxygen enriched assisted ventilation with the airway secured in place with tape

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85
Q

Which of the following has a direct positive chronotropic effect on the heart?

Isoprenaline infusion

GTN infusion

Verapamil

IV furosemide

Disopyramide

A

Isoprenaline is a chronotropic agent and is occasionally used in bradycardic states

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86
Q

Chvostek’s sign

A

Spasm of the facial nerves following tapping the facial nerve below and in front of the ear.

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87
Q

Acute cheek swelling, lethargy, fluctuating pyrexia, pain on clenching jaw

A

Dental abscess

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88
Q

What can differentitate between sinusitis and dental problems

A

Sinusitis is very unlikely without nasal symptoms

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89
Q

What is the commonest casue of otological pain without ear involvement?

A

TMJ dysfunction

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90
Q

PAWP=

A

LV end diastolic pressure

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91
Q

Sac in exomphalos

A

Always present though may be ruptured

Has three layers- peritoneum, Wharton’s jelly, amnion.

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92
Q

Gastroschisis

A

Has no sac and is rarely associated with other congenital defects, though may be seen in conjunction with intestinal atresia.

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93
Q

Management of gastroschicisis

A

Clingfilm to prevent heat and moisture loss

IV acess-> IVF

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94
Q

Ix in mammary fistula

A

Mammography

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95
Q

Minimum length of time for callus to become visible on plain XR?

A

3-4/52

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96
Q

Lidocaine vs bupivacaine

A

Bupivacaine is more lipophillic so has a longer duration of action

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97
Q

What is a concerning symptom implying malignant transformation in pleomorphic adenoma?

A

Rapid enlargement

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98
Q

Colle’s fascia

A

Continuation of Scarpa’s fascia into the perineal tissues

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99
Q

Which clinical structure is likely to be damaged in a laceration of the dorsum of the foot anterior to the medial malleolus?

A

Great saphenous vein

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100
Q

Relationship between dorsalis pedis and EHL?

A

Dorsalis pedis lies between the EHL medially and the deep peroneal nerve, which lies between the two

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101
Q

What is the most common subtype of malignant melanoma?

A

Superficial spreading, accounts for 70% of cases

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102
Q

What is the epidemiology of acral lengtio melanoma?

A

Accounts for 2-8% of melanomas in caucasians but 80-90% in non-caucasians.

Affects the palms and soles of the feet or beneath the nail bed (subungal variant)

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103
Q

How to demonstrate sciatic nerve compression clinically?

A

Symptoms exacerbated by passive extension of the knee which can be combined with dorsiflexion of the foot.

And immediately relieved by knee flexion

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104
Q

65 y/o woman

Bone pain

Renal failure

Pneumoccocal pneumonia

Bone marrow biopsy likely to show?

A

Plasma cells- multiple myeloma

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105
Q

Supratrochlear nerve is a direct terminal branch of which nerve?

A

Frontal nerve

Supplies the superomedial orbital skin, superior to the medial canthus.

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106
Q

Divisions of V1?

A

Frontal

Lacrimal

Nasociliary

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107
Q

Branches of the nasociliary nerve?

A

Long and short ciliary nerves

Anterior and posterior ethmoidal nerves

Infra-trochlear nerve

Communicating branch to the ciliary ganglion

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108
Q

Innervation of the lacrimal nerve

A

No branches

Supplies the skin above the lateral canthus

Carries parasympathetic fibres from the ptergyopalatine ganglion to the lacrimal gland from the zygomaticotemporal nerve

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109
Q

54 y/o health conscious lady.

Takes multiple vitamin and mineral supplements.

Takes bendrofluazide 2.5mg for HTN.

Blood tests show Ca concentration of 2.84 mmol/l

What is the most likely cause?

Diuretic

High dietary Ca intake

High dietary Vit D intake

Occult malignancy

Primary hyperPTH

A

Thiazides cause hypercalcaemia but it is typically mild.

Vitamin D ingested in its non-hydoxylated form is metabolically inactive so is less commonly a cause of hypercalcaemia.

Intestinal absorption of Ca similarly is tightly regulated so high intake would not cause hypercalcaemia.

The two most common causes are hyperPTH and malignancy. In an asymptomatic individual, hyperPTH is more likely

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110
Q

Action of calcitonin?

A

Inhibits osteoclastic bone resorption

Increases renal excretion of Ca and phosphate

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111
Q

N2 in colorectal cancer staging?

A

N2 represents four or more peri-colic/peri-retal nodes containing disease

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112
Q

Hydraulic conductivity

A

Filtration rate per unit of pressure across a membrane

As Lp increases the net filtration will also

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113
Q

Meralgia paraesthetica

A

Irritation of the lateral cutaneous nerve of the thigh causing sensory changes in its distribution without any motor changes.

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114
Q

Piriformis syndrome

A

Occurs when the sciatic nerve is compressed or impeded by the piriformis muscle.

Should be considered if no spinal cause can be determined for symptoms of sciatica

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115
Q

What is the commonest associated condition with myelomeningocele that should be checked for?

A

Hydrocephalus, seen in 80-90%

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116
Q

If the pateints left hip drops while he stands on his right leg during Trendelenberg’s test, what is the cause?

A

Weakness of right hip abductor muscles

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117
Q

Anaplasia

A

Loss of differentiation of cells and of their orientation to each other

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118
Q

Neoplasia

A

Formation of new tissue, can be benign or malignant

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119
Q

Causes of MR

IF CREEP

A

Infective endocarditis

Functional (LV dilatation)

Cardiomyopathy/congenital

Rheumatic fever/rupture chordae tendinae

Elderly calcification

Ehlers-Danlos

Papillary musle dysfunction/rupture

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120
Q

Autosplenectomy

A

Seen in SCD by late childhood/teenage years

Vaso-occlusive crises are caused by sickle-shaped RBCs that obstruct blood flow to organs-> ischaemia, pain and organ damage.

The spleen is frequently affected.

It is usually infarcted before the end of childhood in children with SCA.

This autosplenectomy increases the risk of infection with encapsulated orgnanisms

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121
Q

On which adrenergic receptor dose salbutamol work?

A

Beta 2

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122
Q

Where are beta 3 adrenoreceptors found?

A

Adipose tissue

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123
Q

How is cardiopulmonary bypass usually instituted?

A

Via the ascending aorta and the right atrium

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124
Q

Ventilation in cardiopulmonary bypass

A

Not necessary as the machine oxygenates the blood

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125
Q

What is the risk of a second child having a cleft palate?

A

4%

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126
Q

10% weight loss has what benefit with respect to heart disease?

A

20% reduction in the risk of heart disease

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127
Q

At what rate does the mucociliary escalator move?

A

2cm/min

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128
Q

What protein is absent in kartagener’s syndrome?

A

Dynein

Integral cytoskeletal motor protein required to control the beat of the cilia lining the respiratory tract

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129
Q

Cartilage in the respiratory tract

A

Unlike bronchi, bronchioles do not have any cartilage in their walls

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130
Q

What factors reduce myocardial blood flow?

A

Pain and vasopression

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131
Q

Criteria for massive blood loss?

A

Loss of >50% of blood volume in 3h.

Loss of >100% of blood volume in 24h

or >150ml of blood loss per minute

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132
Q

What is true wr.t. colloids in peripheral oedema

A

Excessive use of colloids may worsen peripheral oedema, if there is loss of capillary wall integrity, the colloid will leak into the interstitial fluid compartment

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133
Q

Inheritance of a1AT disease?

A

AR metabolic condition associated with mutations in multiple genes predisposing to obstructive pulmonary disease and liver cirrhosis

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134
Q

Pathophysiology of a1AT deficiency

A

Antitrypsin is a serine protease inhibitor that normally binds to proteins released by WBCs in inflammatory conditions such as elastase, preventing their action in normal tissues.

In a1AT deficiency, protein configuration is altered, leading to prevention of its release from hepatocytes and therefore a reduction in the circulating concentration.

This allows elastase to digest alveolar walls and leads to pan-lobular emphysema in the lungs.

In the liver, conversely, it is the excess of a1-antitrypsin and its retention in the endoplasmic reticulum that leads to hepatocyte necrosis and liver cirrhosis.

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135
Q

Budd-Chiari syndrome

A

Abdominal ascites, hepatomegaly and abdominal pain.

Caused by obstruction of the hepatic venous system.

Can be thrombotic or non-thrombotic but venous stasis causes oedema of the tissues, hepatomegaly and severe pain with liver capsule stretching.

If it is not detected and treated early it can lead to sinusoidal necrosis and liver fibrosis.

In its fulminant form it can present with liver and renal failure but has not been assocaited with lung emphysema

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136
Q

CF in the liver

A

Most commonly presents as fatty liver.

Billiary cirrhosis and portal hypertension can also occur.

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137
Q

Surgical position in APER

A

Lloyd-Davies position

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138
Q

Llyod Davies

A

Supine with legs in supports that flex the hips and knees to 45 degrees.

The legs can then be separated to allow access to the abdomen and perineum at the same time.

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139
Q

Surgical position for long saphenous vein stripping

A

Trendelenberg

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140
Q

Trendelenberg position

A

Patient supine with head down tilt.

Helps alleviate pressure in the lower limb venous system and can decrease intra-operative blood loss.

Can also be used in pelvic surgery to keep bowel loops out of the operating field

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141
Q

Reverse trendelenberg

A

Head up position.

Where the abdominal contents need to fall away from the region of intervention

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142
Q

Surgical position for arthroscopic rotator cuff repair

A

Armchair

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143
Q

Where is the FAP gene?

A

5p

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144
Q

Nitric oxide is derived from what?

A

L-arginine by nitric oxide synthase

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145
Q

Nitric oxide

A

Used to be known as endothelium-derived relaxing factor.

Local cellular messenger derived from L-arginine by nitric oxide synthase.

It increases the levels of intracellular GMP.

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146
Q

Giacomini vein

A

Anatomical variation thought to be present in 75% of the population

It is a superior extension of the short saphenous vein that continues into the thigh.

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147
Q

To what confounding bias are screening programmes for cancer susceptible?

A

Lead-time bias

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148
Q

Lead-time bias

A

Occurs when screening advances the date at which diagnosis is made.

This lengthens the calculated survival time without necessarily altering the date of death.

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149
Q

Length-time bias

A

Can also affect screening programmes.

Tendency for screening to detect a disproportionate number of cancers that are slow growing and have a better prognosis anyway

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150
Q

Detection bias

A

Occurs when a phenomenon is more likely to be observed for a particular set of study subjects.

Leads to false inflation of a particular phenomenon because the study authors are more likely to look for it within a set group.

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151
Q

Painful arc

A

50 to 130 degrees of abduction

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152
Q

Acute response to hypoglycaemia

A

Increase in serum adrenaline

Glucagon

Both of which are gluconeogenic.

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153
Q

Formation of the internal jugular vein

A

Receives the facial, pharyngeal, lingual and superior and middle thyroid veins.

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154
Q

Formation of the external jugular vein

A

Arises from the junction of the posterior auricular vein and the posterior division of the retromandibular vein

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155
Q

What happens to the anterior portion of the retromandibular vein

A

Proceeds forward to the anterior facial vein and together they join to form the common facial vein.

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156
Q

Which of the following is a tributary of the IJV?

EJV

Inferior thyroid

Middle thyroid

Retromandibular

Transverse cervical

A

Middle thyroid

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157
Q

What proportion of cervical spine fractures are missed on lateral cervical spine views/

A

5-15%

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158
Q

Recommended FiO2 in trauma

A

0.85

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159
Q

Hypotension in trauma

A

Should be assumed to be due to hypovolaemia

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160
Q

Management of high risk papillary thyroid tumour?

A

Total thyroidectomy followed by radioactive iodine.

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161
Q

Management of multi-nodular goitre causing airway compression

A

Total thyroidectomy

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162
Q

Low risk in thyroid malignancy

A

Women 16-48

Papillary carcinomas <1cm

Minimally invasive follicular carcinoma <1cm

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163
Q

High risk factors in thyroid malignancy

A

Men and women outside of the 16-25 age range.

Differentiated carcinoma 1cm (>4cm having poorer prognsois)

As well as any associated with multifocality or local/distant spread

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164
Q

Hypovolaemia and lung compliance

A

Increases due to less blood in the lung making it easier to expand

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165
Q

Croup=

A

Acute laryngotracheobronchitis

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166
Q

What differentiates between acute laryngotracheobronchitis and acute epiglottitis?

A

Epiglottitis affects older children, there is supraglottic oedema (epiglottis is red and swollen and protrudes aove the tongue)= rising sun sign

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167
Q

What part of the airway is susceptible to obstruction due to heat injury?

A

Supraglottic ariway

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168
Q

Clinical indicators of inhalation injury

A

Facial burns

Singeing of the nasal hairs

Carbon deposits in the oropharynx

Carbonaecous sputum

Hoarseness

CarboxyHb >10%

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169
Q

How can the causes of hypokalaemia causing direct renal tubular cell injury be classified?

A

In the presence or absence of hypertension with reference also to plasma renin activity and urinary potassium excretion

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170
Q

Which of the following is a cause of hypokalaemia without hypertension but with high plasma renin actvitiy?

Liddle syndrome

Cushing’s

Liquorice excess

Renovascular disease

Gitelman’s syndrome

A

Gitelman’s syndrome

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171
Q

Hypokalaemic metabolic alkalosis with hypocalciuria and hypomagnesaemia and normal BP

A

Gitelman’s syndrome

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172
Q

Gitelman’s sydnrome

A

AR or AD

Hypokalaemic metabolic alkalosis with hypocalciuria and hypomagneseamia

BP is normal

Disorder caused by mutations resulting in the improper function of the thiazide sensitive Na-Cl symporter in the DCT

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173
Q

Hypokalaemia with hypertension (K excretion usually >30mmol/day) and low plasma renin activity

A

Liddle’s sydnrome

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174
Q

Liddle’s syndrome

A

AD syndrome of HTN and variable degrees of hypokalaemic metabolic alkalosis

Caused by excess reabsorption of Na and loss of K from the renal tubule.

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175
Q

Liquorice excess

A

11 beta hydroxysteroid dehydrogenase metabolises cortisol and prevents it from bindging tothe MC receptor

Liquorice inhibits 11 beta hydroxysteroid, preventing the metabolism of cortisol to coritsone.

These patients have a Conn’s phenotype

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176
Q

Surgical management of umbilical hernia

A

Mayo repair (vest-over pants approach)

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177
Q

What proportion of patients require re-operation in TURP?

A

2%

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178
Q

Which of the following conditions can cause a macrocytic anaemia?

ACD

Dietary Fe deficiency

Recovery from acute haemorrahge

Sideroblastic anaemia

Thalassaemia

A

Recovery from acute haemorrahge as it causes a reticulocytosis

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179
Q

Gumma of the testis

A

Due to syphillis

Hard insensitive mass involving the testis which is difficult to distinguish from a tumour

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180
Q

PaCO2 in severe exercise

A

PaCO2 is often lowered

Due to increase in ventilation

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181
Q

Which of the following may lead you to suspect inflammatory AAA?

Always associated with raised ESR

Can present with renal failure

More common in women

Responsible for 20% of all AAAs in smokers

Most commonly detected intra-operatively.

A

Inflammation involves the retroperitoneum-> RPF causing entrapment of the ureturs and subsequently progressive renal failure

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182
Q

Inflammatory AAAs

A

Variant of AAA found in 5-10% of all cases.

Found in younger patients, infrarenally and symptomatic.

RFs include male, smoker, FHx.

Commonly associated with raised ESR (90%).

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183
Q

CT finding in inflammatory AAA

A

Cuff of perianeurysmal tissue and inflammatory chagnes that spare the posterior wall.

Radiological appearances relate to thickening of the adventitaia with abdundant inflammatory cells.

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184
Q

Urine testing positive for blood but no RBCs seen on urine sediment microscopy may be caused by?

A

Myoglobinuria.

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185
Q

Can the subclavian artery be sacrificed if damaged intra-operatively?

A

No it supplies the thyroid, breast, rectus abdominus, brainstem and diapragm

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186
Q

How to calculate renal clearance of a substance?

A

UXV/P

where U= urine concentration

V= urine production ml/min

P= plasma concentration in mg/ml

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187
Q

What is the clearance of 10ml of an IV substance, which has been administered at 10mg/ml.

The plasma concentration at equilibration is 15mg/litre

Urine concentration is 150mg/litre

Subject produces 1440ml of urine during 24h collection?

A

10ml/min

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188
Q

Usual cause of jaundice in MODS?

A

Intrahepatic cholestasis and hepatocyte necrosis.

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189
Q

26y/o with passive faecal incontince 3 months post-partum

A

Sphincter disruption.

Obstetric trauma leads to transient feacal incontinence due to traction of the sphincteric complex and pudendal nerve

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190
Q

60y/o with four children presents wtih 3 year history of worsening urge faecal incontinence.

She had two prolonged instrumented deliveries

A

Pudendal neuropathy.

Multiple, traumatic vaginal deliveries will result in stretch injury to the pudendal nerve.

This results in a weakness in the EAS causing attenuated squeeze pressure.

Patients subsequently complain of an inability to defer defecation with incontinence

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191
Q

Treatment of pudendal neuropathy causing urge faecal incontinence

A

Amitryptilline may be of some benefit

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192
Q

Pathophysiology of faecal incontinence

A

Can be a disturbance of the passage or passenger.

Passage consists of the recutm and anal canal, which is composed of two rings of muscle, internal and external anal sphincter.

Pudendal nerve is a mixed nerve that provides motor function to the EAS as well as sensation to the anal canal that provides sensory input that forms part of the sampling reflex.

The passenger (feaces) if loose may cause incontinence even in the presence of a normally functioning anorectal sphincteric complex.

Alternatively, sphincteric disruption may lead to incontinence, even for normal stool

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193
Q

Rare form of chronic cholecystitis characterised by huge numbers of lipid-laden macrophages and giant-cells

Can easily be mistaken for carcinoma

A

Xanthogranulomatous cholecystitis

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194
Q

Life threatening conditions in the ATLS primary survey

ATOMIC

A

Airway obstruction

Tension pneumothorax

Open pneumothorax

Massive haemothorax

Incipient flail chest

Cardiac tamponade

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195
Q

Management of bladder tumour T2-4a

A

Cystectomy +/- RTx + CTx

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196
Q

Muscle invasive bladder tumour

Pelvic lymph nodes

A

Cystectomy contraindicated

Use of M-VAC CTx is indicated instead

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197
Q

CTx in bladder Ca

A

M-VAC

Methotrexate

Doxorubicin

Cyclophosphamide

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198
Q

Course of the ejaculatory duct

A

Formed by the union of the duct from the seminal vesicles with the ductus deferens.

Commence at the base of the prostate and run forward and downward between its middle and lateral lobes along the sides of the prostatic utricle.

To end by slit like orifices close to the utricle in the prostatic urethra

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199
Q

Terminal part of the profunda femoris is sometimes known as?

A

The fourth perforator

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200
Q

Origin of FDP?

A

Upper 3/4 of the anterior and medial surfaces of the ulnar, interosseous membrane and deep fascia of the forearm.

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201
Q

Insertion of FDP

A

Into the base of the distal phalanx

202
Q

Pathophysiology of gallstones in Crohn’s disease

A

Bile acids are normally excreted into the small bowel from the liver and gallbladder and are reabsorbed in the terminal ileum = enterohepatic circulation.

In terminal ileal Crohn’s this reabsorption of bile satls is impaired and there is net loss of the available bile salt pool.

There is insufficient concentraion of bile salts to emulsify the cholesterol which subsequently forms cholesterol gallstones

203
Q

Indirect signs of facial fracture

A

Soft tissue swelling

Periorbital or intracranial air and fluid in the paranasal sinus

204
Q

XR views in ?facial #

A

Water’s view (PA with cephalad angulation)

Caldwell (PA view)

Lateral view

Occipitosubmentovertex view

205
Q
A

Water’s view

Tends to show all facial structures the best

206
Q
A

Lines of Dolan

Three anatomic contours that correspond to facially important structures

  1. orbital
  2. zygomatic
  3. Maxillary
207
Q
A

Caldwell view

208
Q

Which of the following is most closeley associated with nasopharyngeal carcinoma?

Woodwork

Afro-caribbean

EBV

Vit DD

Female

A

EBV

Woodwork is associated with paranasal sinus (classically ethmoidal) carcinoma, not NP carcinoma

209
Q

Alternative to MRI in ?cauda equina

A

CT myelogram in those unable to undergo MRI e.g. with pacemaker

210
Q

From what area is most fat absorbed in the GIT?

A

Proximal small intestine

FFAs are taken up into enterocytes via a protein-dependent active transport.

Once in the enterocyte, they reform triglycerides and are repackaged into chylomicrons with cholesterol.

Some short chain FAs are transported via diffusion

211
Q

What otological pathology is not detected by a bone conduction test?

A

Fibrosis causing fixation of the ossicles.

Because the choclea is embedded in bone, vibrations in the bone can be transmitted directly to the cochlear fluid.

Damage to the ossicles or tympanic membrane are thus not detected on a bone conduction test

212
Q

Superficial to deep arrangement of structures at the lateral aspect of the knee?

A

Skin, fibular collateral ligament, popliteus muscle tendon, lateral meniscus

213
Q

Natural history of appendicitis?

A

Resolve

Become gangrenous and perforate

or

Become surrounded by a mass of omentum and small bowel that walls of the inflammatory process (appendix mass).

214
Q

>1/52 history of RIF pain.

Persistent low grade fever

Mild tachycardia

A

?Appendix mass

215
Q

How to differentiate clinically between appendix mass and appendix abscess

A

Appendix abscess usually becomes systemically unwell with intermittent swinging pyrexia, rigors and profuse sweating.

Drainage is the best initial treament, in contrast to appendix mass where first line management is conservative

216
Q

Modified Astler Coller staging system

A

Modification of Duke’s system

217
Q

MAC A

A

Modified Astler-Coller

Limited to mucosa

218
Q

MAC

B1

A

Tumour extending into but not through the muscularis propria

219
Q

MAC

B2

A

Tumour penetrating through the serosa but no involvement of LNs

220
Q

MAC

B3

A

Tumour invades adjacent structures

221
Q

MAC

C1

A

Same as B1 plus regional node mets

222
Q

MAC C2

A

Same as B2 plus regional node mets

223
Q

MAC C3

A

Same as B3 plus regional node mets

224
Q

MAC D

A

Distant mets

225
Q

Why is the risk of HIV transmission higher with hollow needlestick injury?

A

Hollow needles potentially contain more blood and the risk of HIV transmission is related to the amount of blood and viral concentration load

226
Q

Renal hypoperfusion is associated with what biochemical changes

A

Avid sodium retention with minimal excretion into the urine (<20mmol/l)

Increased osmolality and creatine excretion

227
Q

Urinary osmolality >500

Urinary sodium excretion <20

Urinary creatinine >40

A

Pre-renal cause

228
Q

Urinary osmolality <350

Urinary sodium excretion >40

Urinary creatinine <20

A

Renal cause

229
Q

Double bubble sign on plain AXR in neonate

A

Duodenal atresia

230
Q
A

Double bubble sign

?duodenal atresia

231
Q

A “cone” on contrast enema in a neonate

A

Hirschprung’s disease

232
Q
A

Cone on contrast enema- Hirschprung’s

233
Q

Capacitation of sperm involves

A

Glycoprotein molecules coating the sperm are solubilised by uterine fluid.

This enhances sperm motility and allows the head to penetrate an egg

234
Q

Which of the following is an example of a non-absorbable suture?

PDS

Polygalactin

Polyglycolic acid

Polygylconate

Polypropylene

A

Polypropelene (prolene)

235
Q

Indications for tracheostomy

CRIMP PRINTS

A

Congenital (laryngeal webs, subglottic stenosis)

RTx causing neck stenosis

Infections e.g. epiglottitis

Malignancy

Protection of bronchotracheal tree

Paralysis (bilateral) of cords

Respiratory failures

Intubation (prolonged)

Neurological

Trauma to upper airway

Secretions (bronchial)

236
Q

Impact of tracheostomy on anatomical dead space

A

Tracheostomy reduces the fraction of tidal volume not participating in gas exchange thereby reducing dead space.

Also assists in reducing the work of breathing

237
Q

Impact of tracheostomy on V/Q mismatch

A

Reduces V/Q mismatch as reduces anatomical dead space

238
Q

Impact of extracellular fluid depletion on [K]

A

ECF depletion leads to RAAS activation increasing renal Na reabsorption and K excretion

239
Q

Action of glucagon

A

Acts on liver to promote gylcogenolysis and gluconeogenesis

Increases lipolysis in adipose tissues and increases ketone body production from FAs.

Action on adipose tissue mediated by cAMP to stimulate lipolysis producing FFAs that can act as a major alternative enregy source.

Catecholamines act in a similary way to glucagon but have effects on muscle

240
Q

Definition of ARDS

A

Berlin definition

Acute <1/52 onset

Bilateral opacities consistent with pulmonary oedema on radiograph

Such changes are not secondary to cardiac failure or fluid overload.

Specific ventilatory requirements.

241
Q

What are the specific ventilatory requirements required for a diagnosis of ARDS?

A

PaO2 ratio <300 mmHg with a minimum of 5cm H2O PEEP

A normal PF ratio is approximately 500mmHg and a PEEP of 5-15

242
Q

Structures at risk of injury during midline sternotomy incision?

A

Brachiocephalic trunk

LCA

Left subclavian

Both brachiocephalic veins

Trachea

Oesophagus

Phrenic nerves

Both vagi

Thoracic duct

Left RLN

Thymus in children

243
Q

Course in the internal thoracic/internal mamary arteries?

A

2cm lateral to the lateral edge of the sternal border

244
Q

Mechanism of injury in posterior shoulder dislocation

A

Direct blow to the front of the shoulder or forced internal rotation when the arm is abducted.

245
Q

Treatment of #shaft of humerus

A

Hanging cast, the weight of which maintains reduction

246
Q

Clinical features of olecranon fracture

A

Two types of injury are commonly seen

First is comminuted fracture following direct trauma to the point of the elbow.

Second is a traction injury to the olecranon resulting in a transverse fracture. This typically occurs following a fall onto the hand with triceps contracted.

Transverse fractures tend to cause disruption of the extensor mechanism of the elbow as in the case described.

Displaced fractures may result in a palpable gap.

247
Q

Muscles attached to the greater trochanter of the femur?

A

Piriformis

Gluteus medius

Gluteus minimus

Obturator internus

Obturator externus

Vastus lateralis

Gemeilli

248
Q

Attachement of gluteus maximus to femur

A

Gluteal tuberosity

249
Q

Pathophysiology of AV fistulae

A

Can present immediately after traumatic injury because bleeding occurs into a space that is confined by surrounding tissues.

If AV shunt is large, ischaemia of the distal extremity may occur.

The recirculation of large amounts of blood in a left to right shunt can lead to cardiac failure

250
Q

Resolution of AV fistulae

A

Spontaneous resolution occurs in <3% usually via thrombosis.

As such early operative repair is usually indicated as most will increase in size

251
Q

What is the most important preoperative test ahead of thyroglossal cyst removal

A

Thyroglossal cysts can contain the only functioning thyroid tissue in the body, isotope scans should thus be planned before surgery to identify all functioning thyroid tissue

252
Q

Ix in 35y/o lady with passive and urge faecal incontinence following obstetric injury

A

Endoanal ultrasound- allows visualisation of the internal and external anal sphincters.

Anorectal manometry and rectal sensory thyresholds may also be used

253
Q

Part of the right bundle branch of the AV bundle is carried by which structure?

A

Moderator band, which runs from the interventricular septum to the anterior papillary muscle of the right ventricle. It carries the right bundle branch to the anterior papillary muscle.

254
Q

What clinical feature may give a clue to early CMV pneumonitis in immunocrompromised?

A

Respiratory distress noticed at first during exercise.

255
Q

Classical HTN in chronic rejection of transplanted kidney?

A

Diastolic classically rises in advance of systolic component

256
Q

Fluid filled meningeal sac with CSF in the lower lumbar region without cord

A

Meningocele

257
Q

Fluid filled sac in lower lumbar region filled with CSF and SC

A

Myelomeningocele

258
Q

Where is folate absorbed?

A

Jejunum

259
Q

UOQ breast lesion in 54 year old lady.

No abnormality on mammogram but 21mm irregular mass on USS

?lesion

A

Lobular carcinoma can be mammographically occult

260
Q

Stability of pelvic fractures:

Lateral compression fracture

A

Rotationally unstable, vertically stable pelvic fracture.

261
Q

Lateral compression pelvic fracture

A

Most common form of pelvic fracture

Transverse fracture of pubc rami and ipsilateral/contralateral to posterior injury.

Described by both anterior and posterior pathology.

Pelvic ring implodes or collapses and one side rotates medially towards and occasionally beyond midline.

Often these have rotational instability with verticle stability.

262
Q

Association of lateral compresion pelvic fractures

A

Most common identifiable cause of death is closed head injury.

May result in major haemorrhage if one of fracture fragments directly tears one of the large pelvic vessles

263
Q
A

Lateral compression fracture

264
Q

Stability of pelvic fractures:

Open-book fracture

A

Rotationally unstable, vertically stable pelvic fracture

265
Q

Open book pelvic fracture

A

Most often the result of high-energy trauma and are associated with significant morbidity and mortality due to associated vascular injuries

Result from AP compression injury to the pelvis and result in a combination of ligamentous rupture and or fractures to both the anterior and posterior arches.

May be associated with urethral injury

266
Q
A

Open book fracture

267
Q

Stability of pelvic fractures:

Vertical shear injury

A

Rotationally unstable, vertically unstable pelvic fractures

268
Q

Vertical shear pelvic fracture

A

Unstable ipsilateral anterior and posterior fractures of the pelvic ring, with resultant superior displacement of one hemipelvis. Also known as the Malgaigne fracture.

High energy blunt trauma, with significant axial loading

Most commonly a fall or jump from a height with impact onto the lower extremities

Pelvic ring is disrupted, with both anterior pelvis injury (pubic rami), and ipsilateral posterior pelvis injury (sacrum, SI joint, iliac wing)

Ruptures the sacrotuberous and posterior sacroiliac ligaments which provide vertical stability to the pelvis

As a result, the “lateral fragment”, the fracture component containing the acetabulum, is displaced superiorly

269
Q

Malgaigne fracture

A

Pelvic vertical shear fracture

270
Q

Pelvic fracture stability:

Isolated iliac wing fracture

A

Rotationally and vertically stable

271
Q
A

Vertical shear fracture

272
Q

Isolated iliac wing fractures

A

Most are unstable.

Typically progress form iliac crest to GSF

Have high incidence of associated injuries- bowel injuries, bowel entrapment, soft tissue degloving

273
Q

Pelvic fracture stability:

Isolated pubic ramus fracture

A

Rotaionally and vertically stable

274
Q

Acid base disorder in aspirin posioning

A

Respiratory alkalosis and metabolic acidosis

275
Q

What structure crosses the midline at T5?

A

Thoracic duct

276
Q

Maliginant otitis externa

A

Erosive inflammatory process which occurs typically in immunocompromsied individuals

277
Q

Open repair of inguinal hernia in women

A

Lower part of the mesh is fixed to the reflected edge of the inguinal ligament with the mesh positioned to reinforce the posterior wall of the canal (Lichtenstein repair)

278
Q

Nerve block for inguinal hernia repair

A

Infiltration of the iliohypogastric and ilioinguinal nerves T12 and L1. 2cm medial from ASIS

and

Genitofermoal nerve 1-2cm lateral to the pubic tubercle

and

Local infiltration of the subcutaneous tissues along the line of incision

279
Q

Consequence of superior laryngeal nerve damage?

A

Subtle and may only be noticed by professionals that rely on their voice.

280
Q

Tracheolamalacia

A

Rare consequence of long-standing goitre where the tracheal cartilages become soft due to prolonged tracheal compression

281
Q

Mortality in intermittent claudication?

A

30% of patients will be dead in 5 years, mainly from cardiac and cerebrovascular disease

282
Q

FRC is approximately what in a healthy adult man?

A

2.5L

283
Q

Features of thyroid malignancy

A

Hard fixed mass

Raised calcitonin levels

History of neck irradiation

Nerve palsy

284
Q

What is the most common limiting cause of survival of LT heart transplants?

A

Cardiac allograft vasculopathy (i.e. coronary atherosclerosis)

285
Q

What are the 3 mechanisms of heart transplant rejection?

A
  1. Acute cell mediated rejection T-cell mediated.
  2. Ab mediated rejection
  3. Cardiac allograft vasculopathy
286
Q

Cardiac allograft vasculopathy

A

Form of accelerated coronary artery disease that presents in the transplanted heart months to years following transplantation.

It is though to occur to some extent in 42% of heart transplant patients 3 years after transplant.

Presents histologically as a diffuse proliferation of the intima involving the coronary arteries, intramyocardial vessles and coronary veins resulting in concentric luminal narrowing of the vessel.

This condition is the primary limiting factor for survival of heart transplant and is thought to be 2o to a combination of immune and non-immune factors with hyperlipidaemia and insulin resistance beign the two most significant non-immunological factors.

287
Q

Causes of constrictive pericarditis

A

Infection

RTx

Cardiac surgery that required opening of the pericardium

288
Q

Pericardial biopsy showing fibrous thickening, inflammation, granuloma and associated calcification

A

?constrictive pericarditis

289
Q

Cardiac biopsy showing virus inclusions in myocardial fibres

A

?Cytomegalovirus myocarditis

290
Q

Which artery is vulnerable to rupture in ACL injury?

A

Branches of the middle geniculate artery

291
Q

What proportion of cancers are caused by oncoviruses?

A

Up to 20%

292
Q

Cardiac conduction blocks occuring below the AVN known as

A

Infra-Hisian blocks

293
Q

Where is Fe absorbed?

A

Duodenum

294
Q

Gram positive, rod-shaped exotoxin producing bacteria that are spore bearing and area anareobes with varying degrees of resistance to o2 toxicity?

A

Clostridia

295
Q

Haemorrhagic indication for emergency thoracotomy?

A

Persistent haemorrhage of at least 200ml/h for four or more hours

296
Q

ITU syndrome

A

Illness that affects patients recovering from major illness or operations and manifests by impairment of memory and perception.

Patients may be unable to hold a conversation, this could be due to sleep deprivation, pain, anxiety or fear

297
Q

What are the four anterior bursae of the knee?

A

Suprapatellar, prepatellar, superficial infrapatellar and deep infrapatellar

298
Q

What are the two posterior bursae of the knee?

A

Popliteal and semimembranosus

299
Q

Natriuresis in a dehydrated hyponatraemic patient suggets

A

Uncontrolled renal loss of sodium as occurs in adrenal failure

300
Q

Cerebral salt wasting

A

Typically occurs following a head injury or brain surgery

Can cause dehydration and hyponatraemia due to excessive natriuresis

301
Q

Significance of the parietal pleura in nephrectomy?

A

The lower border of the parietal pleura crosses the twelfth rib, the lateral border of the erector spinae and passes horizontally to the lower border of the twelfth thoracic vertebra. There is thus a triangle of pleura in the costovertebral angle below the medial part of the twelth rib behind the upper pole of the injury.

302
Q

Likelihood of damage to adrenal glands during nephrectomy?

A

Relatively well protected anatomically, lying anterosuperior to the upper part of each kidney within their own compartment of renal fascia.

303
Q

Approach to ureteric anastomosis following renal transplant

A

Extravesical approach: direct anastomosis to the bladder mucosa

Intravesical approach: through a submucosal tunnel and suturing inside the bladder through a separate incision in the bladder wall

304
Q

End to side ansatomosis in renal transplant

A

Is to the external iliac artery and vein

305
Q

End to end anastomosis in renal transplant

A

Is to the internal iliac artery

306
Q

Free flap and radiotherapy

A

Radiotherapy affects vessel wall composure and immediate free transfers are thus easier than delayed

307
Q

Flap necrosis in free flaps

A

Commonly occurs on the outer zones and for this reason the outer section is often discarded

308
Q

Rate of DIEP flap loss?

A

Up to 10%

309
Q

Vitamin K production

A

Vitmain K is a fat-soluble vitamin absorbed in the terminal ileum with bile salts.

Prolonged diarrhoea/high ilesotomy output may result in abnormalities of vitmain K absorption.

This, combined with treatment with broad-spectrum antibiotics may result in the suppression of noraml gut bacterial flora that are also an important producer of vitamin K.

310
Q

Pre-operative localisation of parathyroid adenoma

A

Can be achieved with US or sestamibi radionucleotide scan

311
Q

Which interleukin promotes mucous secretion

A

IL-1

312
Q

Between what mean systolic BP values is CBF auto-regulated?

A

50-150mmHg

313
Q

Indications for surgical repair of popliteal artery aneursym?

A

Sympomatic patients with acute limb ischaemia or severe claudication symptoms.

Asymptomatic patients with the presence of a thrombus (thrombus in the aneurysmal sac is at high risk of fragmentation with fleixion/extension movements of the knee and can lead to occlusion of the distal vessels and acute limb ischaemia)

314
Q

Diameter of popliteal aneurysm prompting repair

A

>2cm

315
Q

Mechanism through which tongue carcinoma causes death

A

Local complications or aspiration pneumonia

316
Q

In what area of the tongue are carcinomas more common?

A

Anterior 2/3rds

317
Q

What is supplied by the anterior interosseous nerve?

A

FPL and FDP

318
Q

28y/o man

Right tibial pain with palpable swelling

XR shows lytic lesion involving the epihpysis and extending into the soft tissues .

Benign giant cell tumour

Chondroblastoma

Chrondroma

Chrondromyxofirboma

Osteoid osteoma

A

Benign giant-cell tumour

Occur in epiphyses and can erode the rest of the bone and extend into the soft tissues.

They are notorious for their tendency to recur.

Rarely they can metastasize but normally they remain histologicaly benign.

They have a lytic apperance on XR

319
Q

Motorcyclist falls from bike.

On arrival in A+E, extension of the shoulder was severely limited.

Which nerve is he most likely to have damaged?

LTN

Medial pectoral

Suprascapular nerve

TD nerve

Upper subscapular nerve

A

TD is the only nerve listed that is involved in shoulder extension.

The TD innervates lat dorsi which extends and internally rotates the humerus

320
Q

What can happen if central venous line is left open following insertion

A

Venous air emobilism

321
Q

Type 1 endoleak following EVAR

A

Occurs at the proximal or distal ends of the stent graft as a result of an incomplete seal.

In such cases, the aneurysm will continue to expand and remain at risk of rupture

322
Q

Type 2 endo leak

A

More common but less serious

Result in filling up of the aneurysm sac via back bleeding from its minor branches e.g. IMA and lumbar arteries.

They only require treatment if associated with increasing aneurysmal sac size

323
Q

Causes of renal failure post EVAR

A

Contact toxicity

More rarely if the stent graft accidentally covers the origins of the renal arteries

324
Q

Which nerve is at injury following a deep laceration to the thenar eminence

A

The recurrent branch of the median nerve

325
Q

Alvarado score

A

Clinical and laboratory based scoring system which assesses the likelihood of the diagnosis of appendicitis

<5- unlikely

5-6 equivocal and may require scanning

>7 is strongly predictive

326
Q

Components of the Alvarado score

A

Migratory RIF pain (1 point)

Anorexia (1 point)

N+V (1 point)

RIF tenderness (2 points)

Rebound tenderness (1 point)

Fever (1 point)

Leucocytosis (2 points)

Left shift in neutrophils (1 point)

327
Q

Choledochal cysts

A

Congenital abnormalities of the bile duct

Children often present with jaundice and a palpable mass in the RUQ which may be accompanied by hepatomegaly.

Treatment is surgical with complete excision of the cyst and restoration of biliary continuity

328
Q

Cupola

A

Cervical parietal pleuron which extends sliglhty above the level of the first rib into the root of the neck.

329
Q

What proportion of invasive breast carcinomas are ductal

A

70-90%

330
Q

Management of Grave’s disease when medical therapy has failed

A

Total thyroidectomy

331
Q

What bony complication may be commonly expected following gastrectomy with duodenal exclusion?

A

Osteomalacia 10-20 years after surgery

332
Q

What proportion of breast feeding women are affected by breast infections?

A

1 in 3 women,

5-10% of these are affected by a breast abscess

333
Q

Plasma cell mastitis

A

Benign breast condition commonly seen in women >60 and is associated with thickened, calcified secretions in the ducts.

It tends to be bilateral and does not have an associated risk of breast cancer

334
Q

Sclerosing adenosis

A

Proliferative condition of the breast in which there is an increased number of acini and glands in the terminal lobular units which presents as multiple, small firm but tender lumps in the breast.

The lobular units retain their structure but the acini become enlarged and distorted by stromal fibrosis surrounding the units.

It does not cause nipple fissuring

335
Q

Action of the deltoid muscle

A

Abduction of the humerus

Flexion, medial rotation, extension and lateral rotation of the shoulder

336
Q

Dumping syndrome

A

Following gastrectomy and due to absent gastric reservoir, abnormal post-operative gastric motor function and hormonal secretion alteration.

After eating, symptoms are related to the rapid transit of hyperosmolar contents into the small bowel.

Osmotic shifts lead to vasomotor symptoms

Symptoms can include postprandial pain, vomiting and dizziness

337
Q

What proportion of men over 45 are affected by BPH?

A

50%

338
Q

The submandibular gland

Has the facial artery running over it

Has the hypoglossal nerve running through it

Is deep to the hyoglossus muscle

Lies entirely below the lower mandible

Lies below the digastric muscle

A

Has the facial artery running over it.

The facial artery arises from the ECA on the anteromedial surface. It gives off an ascending palatine artery and tonsillar artery.

It passes deep to the posterior belly of digastric and runs on the posterior surface of the submandibular gland

339
Q

Relation of the submandibular gland to the hypoglossal nerve

A

Hypoglossal nerve runs deep to the submandibular gland and is at risk of injury during gland excision

340
Q

Imaging of suspicious renal masss when IV contrast is contraindicated

A

MRI is the chosen modality for staging assessment

MRI appears more accurate in delineating IVC or renal vein involvement in comparison to CT when staging renal carcinoma

341
Q

Sensory innervation of the medial side of the palm

A

Palmar cutaneous branch of the ulnar nerve

342
Q

Sensory innervation of the medial side of the palmar surface of the ring finger

A

Superficial branch of the ulnar nerve

343
Q

Which of the following is the most likely component to be actively absorbed by the colon?

AAs

HCO3

Bile salts

Na

H2O

A

Na

80% of water is absorbed in the small intestine, additionally water absorption in the colon is passive and dependent on the absorption of Na and other solutes

344
Q

Absorption of AAs

A

Majority absorbed in the jejunum and the remainder in the ileum

345
Q

Radial nerve roots

A

C5-T1

346
Q

Action of supraspinatus

A

Intiates the first 15 degrees of abduction and then continues to hold the head of the humerus against the glenoid cavity.

The deltoid muscle then takes over at about 90%

347
Q

Fracture passing transversely across the maxillary sinus and pterygoid plates

A

Le Fort 1

348
Q

Le Fort 3 aka

A

Craniofacial dysfunction

349
Q

Ischial tuberosities in the female pelvis

A

Are farther apart in the female pelvis because of a wider pubic arch

350
Q

Depth of the female pelvis

A

Wider and shallower than the male pelvis

351
Q

Female pelvic apertures

A

Female pelvis has larger superior and inferior pelvic apertures

352
Q

Obturator foramina in the female pelvis

A

Oval in females and round in males

353
Q

Curve of the sacrum in the female pelvis

A

Less curved than in the male

354
Q

How should a traumatically amputated digit be transferred for reimplantation

A

Wrapped in saline-soaked gauze and cooled in ice.

355
Q

Young man stabbed in pericardial region with tachycardia, normotension and normal CXR

Next step

A

Echocardiography to evaluate for pericardial effusion

356
Q

Vessel that passes posterior to the IVC, head of the pancreas and duodenum

A

Right renal artery

357
Q

The early phase of raised ICP causes which of the following?

Decreased pulse pressure

Hyperventilation

Hypotension

Pupillary constriction

Tachycardia

A

Pupils constric intially due to external compression of overlying sympathetic fibres but later dilate when the oculomotor nerve is compressed. As herniation progresses, the contralateral oculomotor nerve may be compressed causing bilateral pupil dilation

358
Q

Management of low flow priapism

A

Urgent decompression with aspiration of blood from the corpora

If there is no change after 10 minutes, try intracavernosal injection of alpha 1 adrenergic agonist every 5-10 minutes until detumesence occurs. Monitor BP and pulse during administration, if these fail after 1h surgical intervention may be required.

359
Q

Management of high flow pripaism

A

Conservative treatment recommended in most cases.

Traumatic or delayed presentations require arteriography, embolisation or ligation of fistula

360
Q

Inheritance of vWD

A

AD

361
Q

Laboratory findings in vWD?

A

Prolonged APTT

Normal PT

Prolonged bleeding time due to platelet adhesion defect

362
Q

Where does the submandibular duct (Wharton’s duct) open?

A

Near the midline in the anterior aspect of the floor of the mouth

363
Q

Carcinoid syndrome is caused by

A

Excess secretion of 5-HT by artegraffin cells

364
Q

Features of carcinoid heart disease

A

Characterised by pathognomic plaque-like deposits of fibrous tissue secondary to elevated levels of serum serotonin.

These deposits occur most commonly on the endocardium of vavlular cusps and leaflets, the cardiac chambers and occasionally on the intima of pulmonary arteries or aorta.

The right side of the heart is more commonly affected because the lung can inactivate humoral substances which protects the left heart

365
Q

What can be used for intraoperative monitoring during carotid endarterectomy?

A

Transcranial doppler ultrasound which measures the flow in the middle cerebral artery and is useful in the intraoperative monitoring and investigation of postendarterectomy neurological episodes.

366
Q

Following laceration to the mandibular branch of the trigeminal nerve, which of the following muscles would remain unaffected?

Anterior belly of digastric

Lateral pterygoid

Masseter

Medial pterygoid

Posterior belly of digastric

A

Posterior belly of digastric is innervated by the facial nerve

367
Q

Alcock canal sydrome

A

Pudendal nerve entrapment

Regular cyclists are at risk.

368
Q

Causes pain, typically worse at night.

Relieved by mild analgesics, especially aspirin.

Characteristic apperance is small radiolucent zone surrounded by larger sclertoic zone

A

Osteoid osteoma

369
Q

What investigation can be performed when osteoid osteoma is suspected?

A

99Tc bone scan

Osteoid osteoma appears as a zone of increased uptake

370
Q

Which of the following is an extra-pulmonary feature of sarcoidosis?

Candidiasis

Goitre

Lichen planus

Macroglossia

Splenomegaly

A

HSM is a rare manifestation of sarcoidosis

Cardiac involvement may also occur in 3% of cases

371
Q

Good prongostic factors in osteosarcoma

A

Young adults

Distally located tumours

372
Q

Management of pretibial lacerations in the elderly

A

Need careful management. The skin in this area is friable and wound healing poor.

Sutures may further compromise the blood supply to the flap and place undue tension on the wound.

Adhesive strips are recommended as they keep the edges opposed but do not interfere with the underlying tissue.

373
Q

Closure of fasciotomies

A

Split thickness skin grafting is the most common procedure to close fasciotomy wounds.

374
Q

Where would you visualise an azygos lobe on CXR?

A

Azygos lobe is commonest accessory lobe and is an embryological variant.

Lobe is seen superior to the right hilum, separated from the rest of the lung by a groove containing the azygos vein. it is not a true lobe as it does not have its own separate bronchus

375
Q
A

Azygos lobe

376
Q

In what proportion of routine CXRs is azygos lobe seen?

A

0.5%

377
Q

Glutathione peroxidases

A

Involved in scavenging free radicals

378
Q

Selectins

A

Aid in the initial binding of leucocytes to endothelial surfaces

379
Q

Management of paediatric femoral shaft fractures

A

Commonly treated by skin or skeletal traction, this allows fracture union before the child then commences mobilisation in an approrporiate cast

380
Q

What is of note in the surgical management of paediatric fractures

A

Fixation of fractures, especially IM nailing through an epiphyseal growth plate can disturb bone growth, leading to shortening and malformation of the affected limb, hence it is restricted to the management of the polytraumatised child when plate fixation or external fixation may be used with care

381
Q

Indications for surgical managment of clavicular fractures

A

Open fracture

Polytrauma

Neurovascular injury

Compromise of the overlying skin

Floating shoulder

Symptomatic non-union

Fractures of the lateral third proximal to or between the conoid trapezoid ligamnets

382
Q

Effects of organophosphates on the heart

A

Decrease the rate of rhythmicity of the SAN by inducing hyperpolarisation due to prolonged stimulation with ACh though irreversible inhibition of AChE inhibitors

383
Q

Muscles innervated by the dorsal scapular nerve

A

Rhomboids and levator scapula

These muscles help to retract and elevate the scapula

384
Q

Length of recovery after surgery for unhappy triad of O’Donoghue

A

4-8 months

385
Q

Alteration to the unhappy triad of O’Donoghue

A

Original description was of medial meniscal injury, this was revised in the early 1990s to describe lateral meniscal tears. Hence ACL, MCL and lateral meniscus are most commonly affected

386
Q

Priority of treatment in unhappy triad of O’Donoghue

A

Reconstruction of ACL with graft from either the patellar tendon or semintendinosus.

During the procedure the meniscal tear can also be corrected.

Depending on the degree of injury, the MCL may heal with immobilisation

387
Q

Impact of IPPV on CO

A

IPPV causes an increase in pulmonary vascular resistance and airway presure, a process that interferes with filling of the vena cava and right atrium-> reduced preload-> reduced CO

388
Q

Impact of IPPV on UO

A

Reduces CO leading to ADH release and thus reduced UO

389
Q

Chemotherapy in malignant melanoma

A

Not effective in management. Mainstay of treatment is with surgical excision

390
Q

Which of the following is an example of a newly formed mediator?

Thromboxane

Histamine

Tryptase

Heparin

Eosinophilic cehmotactic factor of anaphylaxis

A

Thromboxane is not pre-formed and results from activation of COX on AA.

391
Q

Which is the ideal suture in closure following ORIF following a fractured distal radius with a subcuticular stitch?

A

Dissolvable suture e.g. 4-0 monocryl

392
Q

Which of the following stimulates the carotid body?

Fall in PaCO2

Fall in PaO2

Fall in pH

Fall in metaoblic rate

Fall in lactate

A

Carotid body is a peripheral chemoreceptort that is stimualted by a drop in PaO2 or rise in PaCO2.

393
Q

To what stimuli do central chemoreceptors in the medulla on the ventral surface of the braisntem monitor w.r.t. ventilation

A

H ion concentration of CSF

394
Q

Lymphoedema praecox

A

Primary lymphoedema occuring before 35 usually around puberty

395
Q

Physiological effects of nitric oxide

A

Relaxation of gastrointestinal smooth muscle and bronchial smooth muscle

Maintenance of vascular integrity

Inhibition of smooth muscle migration and prolifeation

396
Q

Action of LH in male

A

LH promotes testosterone secretion

397
Q

Barium enema in acute colitis

A

Contraindicated due to risk of perforation which would be complicated by barium peritonitis

398
Q

Associations with exomphalos major

A

ToF is the most common

Other abnormalities include renal and external gential anomalies, limb anomalies, ectopia cordis and bladder exostrophy.

399
Q

Def: exomphalos major

A

>5cm defect

400
Q

Associations with exomphalos minor

A

Chromosomal abnormalities

Syndromes

Dysmorphism

GI malformations

CNS malformations

Wilm’s tumour

401
Q

What structures pierce the clavipectoral fascia?

A

Cephalic vein and lateral pectoral nerve

402
Q

Rotter’s nodes

A

Lie between pectoralis major and minor

403
Q

RFs for AAA

A

Smoking

Male

COPD

Previous aneurysm repair or peripheral aneurysm

HTN

CAD

Marfan’s

Ehler’s Danlos

CTD

Inflammation

Vasculitits

404
Q

Triad in inflammatory AAA

A

Abdominal pain

Weight loss

Raised ESR

405
Q

Causes of aneurysm

AMSCTB

A

Atherosclerosis

Mycotic (2o to endocarditis)

Syphillitic

CTD

Trauma

Berry aneurysm and other congenital aneurysms

406
Q

Why is the pituitary gland vulnerable to damage as a consequence of post-partum haemorrahge

A

Low pressure portal venous supply.

Hyperplasia and hypertoorphy of lactotrophs in pregnancy cause it to increase in size

407
Q

Sudden onset headache

Diplopia

Visual field defect

A

?Pituiatry apoplexy

408
Q

Dopexamine

A

Potent splanchnic vasodilator, reducing afterload and improving blood flow to vital organs including the kindney

409
Q

Action of dobutamine

A

Reduces SVR, decreasing afterload and ventricular filling pressures.

Used in cardiogenic shock and cardiac failure

410
Q

Late findings in necrotising fasciitis

A

Severe pain

Purple or black skin discoloration

Blistering

Haemorrhagic bullae

Crepitus

Discharge of dishwater fluid

Severe sepsis

or SIRS

MODS

411
Q

Classification of the complications of otitis media

A

Intratemporal e.g. facial nerve palsy, mastoiditis, petrosis

Extratemporal e.g. Bezold’s abscess

Intracranial e.g. intracranial abscess, VST.

412
Q

Bezold’s abscess

A

A Bezold abscess is a complication of acute otomastoiditis where the infection erodes through the cortex medial to the attachment of sternocleidomastoid, at the attachment site of the posterior belly of the digastric muscle, and extends into the infratemporal fossa. Due to it being deep to the investing layer of the deep cervical fascia that envelops the sternocleidomastoid muscle and trapezius muscle, it is impalpable.

As the mastoid air cells pneumatise late in childhood, a Bezold abscess is seen usually in the adult population where the cortex is thinner.

Due to the close proximity to the internal jugular vein, internal jugular vein thrombosis is a recognised complication.

413
Q

Management of Smith Fracture

A

ORIF using buttress plate because the distal fragment is unstable

414
Q

Positioning to improve refractory hypoxaemia in ARDS

A

Prone or seated position has been shown to improve refractory hypoxaemia caused by ARDS

415
Q

Action of fluoroquinolones

A

Block DNA replication by binding to DNA gyrase, causing ds-DNA breaks in bacterial chromosome

416
Q

Which one of the following physiological responses suggests that a patient is in class II shock?

Decreased pulse pressure

Decreased BP

UO 5-15ml/h

PR >120bpm

Confusion

A

Decreased pulse pressure

Pulse rate is 100-120bpm in class II shock

BP is maintained

UO is 20-30ml/h

Confusion is present in class III shock

417
Q

Does CSF contain less glucose than nasal mucous?

A

CSF contains more glucose than nasal mucus.

A positive glucose dipstix test of clear nasal discharge may indicate a CSF leak though is not a reliable test.

Beta 2 transferrin is more reliable

418
Q

pH of CSF is

A

pCO2 is higher resulting in a lower pH

419
Q

Ophthalmic artery is a branch of which?

ACA

ECA

Facial artery

ICA

MCA

A

ICA

Passes through the optic canal and supplies ethmoidal air cells, part of the lateral wall of the nose, the external nose, eyelids and forehead.

It also supplies all the muscles of the orbit

420
Q

What is the key with mid-oesophageal tumours

A

To exclude tracheal invovlement. If endocsopic US is not possible rigid bronchoscopy could be the investigation of chocie.

421
Q

How can hypoxia be classified?

A

Stagnant hypxoia

Anaemic hypoxia

Histotoxic hypoxia

Hypoxic hypoxia

422
Q

Stagnant hypoxia

A

Results from reduced perfusion of tissues producing a fall in local PO2 where there is inadequate oxygen delivery and extraction to meet tissue demands

423
Q

Anaemic hypoxia

A

Occurs with substantial reductions in blood Hb concentration.

Although PaO2 may be in the normal range, blood O2 content and hence O2 delivery are reduced resulting in local tissue hypoxia.

Similarly reducing the affinity of Hb for O2 also results in a fall in blood O2 content and may induce tissue hypoxia.

424
Q

Hypoxic hypoxia

A

Results from a fall in PaO2 secondary to a reduction in inspired pO2

425
Q

Histotoxic hypoxia

A

Occurs in the presence of metabolic poisons such as cyanide that acts intraceullarly to inihibit the mitochondrial respiratory electron transport chain

426
Q

US features of cysts

A

Hypoechoic centres

Smooth walls

Sharp edges

427
Q

Use of US in assessment of ?breast malignancy

A

Used as an adjunct to mammograph in patients >35

Often primary radiological modality in <35 as breast tissue is too dense for accurate mammographic interpretation

428
Q

Management of bleeding gastric ulcer in patient with multiple comorbidities

A

Consider excision of ulcer due to shorter surgical time.

If perforation is high on the lesser curve, excision can be performed safely without injuring the gastric vasculature

429
Q

At what level does the trachea begin?

A

Cricoid cartilage C6

430
Q

Criteria for admission to hospital following a head injury

A

Patients with new clinically significant abnormalties on imaging

Patients who have not returned to GCS 15 after imaging, regardless of results.

When patient fulfills the criteria for CT scanning but this cannot be done within the appropriate period either because CT is not avaiable or because the patient is not sufficeintly co-operative.

Continuing worrying signs

Other sources of concern e.g. alcohol intoxication

431
Q

Calcification in atherosclerosis

A

Dystrophic calcification

432
Q

Metastatic calcification

A

Calcification occuring in otherwise normal tissue

433
Q

Perineal hernia

A

Seen as a rare complciation fo AP resection and develops though a non-healing perineal wound

434
Q

Excessive salivation

Grey discolouration of the mucous membranes of the mouth

Spreading to the cheeks, palate and nose and a strong odour

<10 years old

Associated with measles, TB and whooping cough

A

?Cancrum oris

435
Q

Bacteria cultured in cancrum oris

A

Borrelia vincenti and fusiform bacilli

436
Q

Pathophysiology of Curling’s ulcer?

A

?gastric erosion secondary to cell ischaemia as a consequence of hypovolaemia

437
Q

Pathophysiology of Cushing’s ulcer

A

Either via direct vagal nerve stimulation or due to the Cushing reflex

438
Q

Validity of health and welfare LPA

A

Does not come into effect until donor loses the capacity to make decisions.

This is in contrast to a financial LPA which can come into effect with permission immediately

439
Q

Potential sequelae of psoas abscess

A

Damage to the femoral nerve

440
Q

Saphenous nerve in adductor canal

A

Enters the adductor canal but leaves without passing through the adductor hiatus.

Courses with the greater saphenous vein.

441
Q

Internal mammary arteries in cardiac bypass

A

LIMA commonly harvested as a pedicle.

RIMA generally skeletonised as injury to the RIMA pedicle may interfere with sternal wound healing.

442
Q

Paget-Schroetter syndrome

A

Thoracic outlet syndrome

443
Q

Which of the following CT findings would you see in EDH?

Crescent-shaped haematoma

Decreased attenuation of the haematoma

Haematoma crossing mid-line

Haematoma crossing suture lines

No associated skull fracture

A

Both SDH and EDH can cross the midline.

Decreased attenuation is a feature of chronic SDH

Crescent shaped haematomas are usually SDH.

EDH cannot cross suture lines and is usually associated with a skull fracture

444
Q

Rate of malignancy in gastrinomas?

A

60% are malignant

445
Q

Which chemokine R is the coR for HIV entry into T cells?

A

CCR5

446
Q

Vascular supply of the SAN

A

60% supplied by RCA

40% by the LCA

Right coronary supplies AVN

447
Q

Lupus vulgaris

A

Mycobacterium of the skin

Appears as sinlge or multiple cutaneous nodules (apple jelly-like) commonly over the face and neck.

Tend to heal in one area and extend to another.

Mucous membranes of nose and mouth sometimes affected.

Infection of the nasal cavity may lead to necrosis of the underlying cartilage.

Treatment is with antitubercular drugs

448
Q

Leser-Tralet sign

A

Multiple seborrhoiec keratosis may rarely be associated with an internal malignancy e.g. CRC

449
Q

Where does the ostea for the posterior ethmoidal sinus drain to?

A

Superior meatus

450
Q

Where does the maxillary sinus drain to?

A

Middle meatus

451
Q

Where does the frontal sinus drain to?

A

Infundibulum (hiatus semilunaris of middle meatus)

452
Q

Where does the anterior ethmoidal sinus drain to?

A

Infundibulum

453
Q

Where does the sphenoidal sinus drain to?

A

Spheno-ethmoidal recess

454
Q

Anaesthetic approach to CABG?

A

Controlled hypotension, controlled hypothermia

Hypothermia reduces the metabolic demand and energy requirements of tissues

Hypotension minimises risk of aortic dissection as a result of the placement of an aortic cannula.

Hypotension also results from the reduced vascular resistance to CP bypass

455
Q

Treatment of tonsillar sarcoma

A

Highly radiosensitive tumours.

Can be treated with tonsillectomy and radiotherapy to decrease the chance of recurrence

456
Q

How to test for the anterior osseous branch of the median nerve

A

Flexion of the thumb at the IPJ

457
Q

Indicator of aggressiveness in malignant melanoma?

A

Satellite lesions

458
Q

Management of acute pulmonary oedema

A

ABC

High flow O2 non rebreathe

IV frusemide

IV morphine

S/L GTN

IV nitrates not routinely used unless concommitant myocardial ischaemia.

Nitroprusside can be used if SBP >100

If SBP 85-100 a vasodilator can still be used with caution or with an inotrope such as dobutamine

If the patient’s SBP <85 then dobutamine can be used but vasodilator should be avoided

459
Q

CEA

A

Glycoprotein involved in cellular adhesion

Normally produced during foetal development but stops before birth and as such is not usually present in the blood of healthy adults though raised levels may be seen in heaby smokers

460
Q

Which muscle tenses the vocal cords?

A

Cricothyroid

461
Q

Course of the femoral artery in the adductor canal

A

Femoral artery is anterior to the vein.

It lies anterior to adductor longus and brevis

It gives of the descending genicular artery in the adductor canal

462
Q

Mortality rate in faecal peritonitits

A

50%

463
Q

Location of the carotid canal

A

Temporal bone

464
Q

Most appropriate management of Colle’s fracture

A

Dorsal back slab applied with the distal fragment in palmar flexion and ulnar deviation

465
Q

Immediate complications of #

A

Haemorrhage

Skin loss

Neurovascular compromise

466
Q

Late complications of fracture

A

Mal-union

Non-union

Arthritis

Sudek’s atrophy

467
Q

Most common testicular malignancy to arise in maldescended testes?

A

Seminomas

468
Q

Why are women more prone to anterior anal fissures?

A

Due to the lack of anterior support to the anal canal

469
Q

Anatomical relevance of the extradural space in LP?

A

Contains loose fat and the extensive vertebral venous plexus of veins

470
Q

What is the most common exta-adrenal site of phaeo?

A

The organ of Zuckerkandl, by the aortic bifurcation

471
Q

The organ of Zuckerkandl

A

The organ of Zuckerkandl is a chromaffin body derived from neural crest located at the bifurcation of the aorta or at the origin of the inferior mesenteric artery. It can be the source of paraganglioma.

472
Q

Def: complete rectal prolapse

A

Involves all layers of the wall and more commonly seen in elderly women.

Partial prolapse only involves the mucosa and more commonly resolves with the conservative treatment

473
Q

What is associated with complete rectal prolpase?

A

Increased risk of rectal carcinoma

474
Q

S1 Q3 T3

A

S wave in lead I

Q wave along with inverted T in lead III

475
Q

Infusion of amiodarone

A

Should be given via a central line

476
Q

What is the risk of re-infarction post-opeartively in a patient who has had an MI 6/52 previously?

A

31-40%

477
Q

Risk of re-infarction post-surgically 3-6/12 after recent MI?

A

16%

478
Q

Risk of re-infarction post-op following MI in last 6/12

A

4-5%

479
Q

How does GH increase blood glucose?

A

Decreases glucose utilisation and cellular uptake.

Increases the mobilisation of FAs from adipose tissues and increases the use of fatty acids for energy

480
Q

Anterolateral border of the adductor canal?

A

Vastus medialis

481
Q

What is the correct position for central venous cannulation with right subclavian line

A

1-2cm below and lateral to the junction between the medial one-third and middle one-third of the clavicle

482
Q

Failed subclavian cannulation on one side

A

Advised not to try on other side due to risk of bilateral pneumothoraces

483
Q

Subclavian line insertion with one unhealthy lung

A

Insert on ipsilateral side to avoid risk of pneumothrax in good lung

484
Q

What is the most common fracture pattern following direct blow with a compressive force to the patella?

A

Stellate

485
Q

Knee flexion trauma to patella, fracture pattern

A

Transverse

486
Q

Management of displaced transverse patellar fractures

A

Surgical fixation

487
Q

Management of comminuted patellar fractures?

A

Can be conservative

488
Q

What may be required in patella fracture

A

Patellectomy may be required to prevent damage to the patellofemoral joint but complete patellectomy should be avoided when possible

489
Q

Pathophysiology of beta-naphthylamine causing bladder cancer

A

Human bladder mucosa secretes beta-glucuornidase which splits beta-naphthylamine and releases a carcinogen.

490
Q

Pathophysiology of swelling in meniscal tear

A

Reactive effusion rather than haemarthrosis

491
Q

Haemarthrosis

Palpable step in tendon

Patient unable to perform a straight leg raise or actively straighten the knee

A

?Extensor mechanism disruption

492
Q

Management of extensor mechanism disruption

A

Direct repair of the tendon as without intervention the mechanism is severely compromised

493
Q

What proportion of patients attending A&E with acute haemarthrosis will have ACL injury

A

80%

494
Q

Uncommon injury caused by twisting of the weight-bearing, flexed kneee

Can occur as isolated injury or in association with major trauma.

Classically known as horseback riders knee it is commonly associated with parachute junmping. Hypermobile individuals are more susceptible.

Examination reveals proximal tibio-fibular joint tenderness and movement of the ankle causes knee pain.

Integrity of the common peroneal nerve must be assessed

A

Proximal tibio-fiobular dislocation

495
Q

Reduction of tibio-fibular dislocation

A

Pressure over the fibular head with the knee flexed

496
Q

Where does gas exchange occur in the bronchoalveolar tree?

A

Final seven branches

497
Q

What proportion of O2 is dissolved in plasma

A

1.5-2%

498
Q

Presence of tumour infiltrating lymphocytes in melanoma

A

Recruited in vertical growth phase to a varying degree.

They can cause regression and are a good prognositc sign

499
Q

Chemotherapy in GIST tumours?

A

Ab to c-kit (CD117) imantinib has shown to be effective in 80% of cases

500
Q

How does the posterior interosseous nerve exit the antecubital fossa?

A

Between the two heads of supinator

MRCS Part A (15 decks)

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