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MRCS Part A > Block 15 > Flashcards

Block 15 Flashcards

1
Q

Stage 1 Pressure sore

A

Non-blanching erythema or redness of the skin in the absence of any breach in the continuity of the overlying skin

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2
Q

Stage 2 Pressure sore

A

Partial thickness loss of skin involving the epidermis and dermis

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3
Q

Stage 3 Pressure sore

A

Full thickness skin loss with exposed subcutaneous tissue but intact fascia

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4
Q

Stage 4 Pressure sore

A

Extending into deeper tissues like muscle, tendon, bones or joints

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5
Q

Pathological process underyling development of bladder divertuclae

A

Hypertrophy of the urinary bladder to counteract bladder outflow obstruction.

With continued obstruction, the intravesical pressure increases causes trabeculation.

When the obstruction is not relieved, the bladder pressure increaes causing herniation of the bladder mucosa through the trabeculation-> sacculation.

Ultimately sacculation leads to the formation of diverticulae

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6
Q

Underlying pathology in fibrocystic breast disease?

A

Hyperplasia of the breast epithelium with an exagerrated physiological response-> cystic

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7
Q

Associations with Wilm’s tumour

A

Absence of the iris

Hemi-hypertrophy of the body

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8
Q

Three variants of Type 4 hypersensitivity?

A

Contact

Tuberculin

Granulomatous

All mediated by T cells

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9
Q

What is the mechanism of immune priviliege of the eye?

A

Beneficial immune response are promoted whilst damaging ones suppressed, rather than reduced immune responses

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10
Q

Composition of pigment gallstones?

A

Calcium bilirubinate

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11
Q

Most appropriate IV nutrition regime for someone suitable for PN?

A

20% dextrose and 10% lipid

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12
Q

In order of frequency, which tumours are most likely to metastasise to the brain?

A

Lung

Breast

Melanoma

Kidney

Colon

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13
Q

What kcal is provided by 5% dextrose?

A

200kcal

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14
Q

Lymphatic spread of pancreatic cancer?

A

To 5 groups of lymph nodes:

Coeliac

Paraduodenal

Lesser curvature

Greater curvature

Hilum of the spleen

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15
Q

What is the most common site of nodal metastases in cervical cancer?

A

Obturator nodes

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16
Q

What are the three lymphatic trunks facilitating drainage of the cervix?

A

Lateral trunk-> obturator, external iliac and common iliac nodes (largest trunk)

Anterior trunk-> EIA

Posterior trunk (in uterosacral ligament)-> common iliac and para-aortic lymph nodes

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17
Q

What structures form the front of the perineum?

A

Pubic arch and arcuate ligament of the pubis

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18
Q

What muscles are found in the superficial perineal pouch?

A

Transverse perineal muscle

Bulbospongiosus

Ischiocavernosus

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19
Q

Names of the cuneiforms?

A

Medial, intermediate and lateral

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20
Q

Waldeyer’s ring?

A

Formed by the arrangement of MALT in the nasopharynx and oropharynx to create a lymphoid ring

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21
Q

Duane’s Syndrome

A

Congenital condition associated with strabismus

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22
Q

From which structure does the ductus arteriosus develop?

A

6th aortic arch

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23
Q

Pathophysiology of bicornate uterus?

A

Forms from failure of fusion of the paired mullerian ducts

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24
Q

Development of the external genitalia in the male fetus is dependent on which hormone?

A

DHT

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25
Q

How do motor neurones leave the spinal cord?

A

Via the ventral root (anterior)

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26
Q

Main blood supply of the spinal cord?

A

Derives from paired posterior spinal arteries and single anterior spinal artery and supplemented by radicular arteries

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27
Q

Which of the following is apparent by the fourth week of embryonal development?

Segmental differentiation of the limbs?

Cerebral hemispheres appear as hollow buds

Cloacal tubercle is evident

Embryo is less curved and the head is relatively large

Nose forms a short flattened projection

A

Cerebral hemisphers appear as hollow buds.

Differentitation of the limbs occurs in 6th week

Cloacal tubercle is evident in the fifth week

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28
Q

Narrowest part of the male urethra?

A

At the external urethral orifice

Membranous urethra is second narrowest part

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29
Q

Which of the following is true regarding lung cancer and its staging?

T1 is a tumour no greater than 1cm

Tumour invading visceral but not parietal pleura is T3

A 3cm node has a 60-70% chance of showing malignant infiltration

Majority of lung lesions are primary lung cancers

Small cell tumours are dervied from bonchopulmonary tissues and include adenocarcinoma

A

A 3cm node has a 60-70% chance of showing malignant infiltration

T1 >2cm

T3 tumours invade parietal pleura

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30
Q

Treatment of Kaposi’s sarcoma

A

Radiotherapy

Surgical excision is of little benefit as the tumour is often multicentric in origin and recurs rapidly

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31
Q

What can be used to stage thymomas?

A

Masaoka system

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32
Q

Which antibitoics are associated with achilles tendon rupture?

A

Quinolones

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33
Q

Coarse linear branching calcification

What type of DCIS?

A

Comedo type

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34
Q

Treatment of MRSA colonisation with mupirocin

A

Cochrane systematic review concluded that there is insufficient evidence to support the widespread use of topical or systemic antimicrobial therapy to eradicate nasal or extranasal MRSA

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35
Q

What type of joint is the manubriosternal joint?

A

Secondary cartilaginous joint

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36
Q

Condylar joint=

A

Allow movement in two planes

e.g. MCP

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37
Q

Development of the male urethra?

A

Posterior segment forms from the urogenital sinus

Spongy urethra forms under the influence of DHT causing tubularisation of the urethral fold

The most distal part of the urethra is thought to be derived from the genital tubercle

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38
Q

What is the most effective method for localising parathyroid adenomas?

A

Bilateral neck exploration

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39
Q

The inferior saggital sinus:

Drains directly into the confluence of sinuses

Is found in the falx cerebelli

Is formed within the free, inferior border of the falx cerebri

Drains into the superior petrosal sinus

Contains valves unlike the other venous dural sinuses

A

It is formed in the free margin of the falx cerebri, not cerebelli

It drains directly into the straight sinus

It has no valves.

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40
Q

The inferior hypogastric plexus

A

Bilateral structure located on either lateral pelvic wall

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41
Q

Which of the following is true regarding the phrenic nerve?

Arises from ventral rami of C2-4

Lies in contact with the pericardium of the right atrium

Lies superficial to the pre-vertebral fascia

Passes medially across the border of stylopharyngeus

Pierces the diaphragm at the level of T12

A

Lies in contact with the pericardium of the right atrium.

It lies deep to the pre-vertebral fascia.

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42
Q

Antianginal mechanism of nitrates mediated predominantly by?

A

Vasodilatation of the venous system, leading to a fall in left ventricular preload

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43
Q

Which of the following is true regarding SGLT receptors?

There are three primary membrane transporters responsible for glucose reabsorption in the kidney

SLGT1 is the main primary transporter responsible for glucose reabsorption in the kidney

90% of glucose reabsorption occurs in the S1 and S2 segments of the PCT

SGLT1 is a low affinity, high capacity transporter requiring one glucose and 2 Na molecules

SGLT is the primary glucose transporter in the GIT

A

90% of glucose reabsorption occurs in the S1 and S2 segments of the PCT, this is due to the action of SGLT2

SGLT is the main transporter in the GIT

There are only 2 renal glucose transporters

SGLT1 is a high affinitiy, low capacity transporter requiring one glucose and two Na.

SGLT2 is a low affinity, high capacity transporter requiring one glucose and one Na molecule

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44
Q

The partial pressure of which gas has the greatest impact on the autoregulation of CBF?

A

PaO2

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45
Q

What is the most common benign tumour of the ovaries in premenopausal women?

A

Dermoid cyst aka benign cystic teratoma

46
Q

What is the most effective modality at detecting early soft tissue changes in RA?

A

US

47
Q

What is the main site of gastric acid production?

A

Body of the stomach

48
Q

What part of the vertebra is responsible for causing spondylosis?

A

Pars interarticularis

49
Q

The straight sinus is formed by the union of

A

The inferior saggital sinus and great cerebral vein

50
Q

What is the paralytic position in RLN palsy?

A

Slightly abducted from the midline

51
Q

Where does the MMA originate?

A

Branches off the maxillary artery in the infratemporal fossa

52
Q

Peri-operative beta blockade and moratlity after major non-cardiac surgery in patients with pre-exisiting cardiac disease?

A

Does not improve mortality

53
Q

Where is Na reabsorbed in the loop of Henle?

A

Thick ascending loop

54
Q

What proportion of sodium reabsorption occurs in the DCT?

A

10%, against electrochemical gradient

55
Q

Where does most of the sodium reabsorption occur?

A

PCT (65%)

56
Q

In a patient developing septic CSVT, the primary site of infection is most likely to be?

Chin

Occipital region

Skin over parotid gland

Pinna of the ear

Upper lip

A

Upper lip, anterior fascia drain drains the upper lip and communicates with the ophthalmic veins in the cavernous sinus.

57
Q

Where does the ICA begin?

A

C4

58
Q

Having first degree relative with testicular teratoma increases risk by?

A

4 times for a father

9 times for a brother

59
Q

Oblique fissure of the lung corresponds to?

A

Medial border of the scapula when the arm is fully abducted

60
Q

Surface markings of the lungs?

A

6th, 8th, 10th ribs

61
Q

Surface markings of the pleura?

A

8th, 10th, 12th

62
Q

Transpyloric plane passes through which border of L1?

A

The inferior border and through the neck of the pancreas

63
Q

Which of the following nerves is embedded in the carotid sheath and thus vulnerable to injury during carotid endarterectomy?

Spinal accessory nerve

Ansa cervicalis

Cervical sympathetic chain

Phrenic nerve

Suprascapular nerve

A

Ansa cervicalis

64
Q

Where is naturally occuring heparin found?

A

Mast cells

65
Q

Changes to blood pressure during exercise?

A

Increase in systolic and reduciton in diastolic

66
Q

What is the value of the normal negative intrathoracic pressure produced during normal breathing?

A

1-3mmHg

67
Q

Which of the following organisms is the most likely cause of a cavitating pnuemonia affecting the right middle lobe in a patient with previous cardiac transplant?

Candida

CMV

Nocardia asteroides

PCP

Strep pneumonia

A

N. asteroides

Infection tends to be subacute in nature and progressive with radiographs showing lobar or multilobar consolidation

68
Q

What is the best modality used to image chemodectoma pre-operatively to plan for surgical excision?

A

IV digital subtraction angiography

69
Q

Traction on which structure during extended right hemicolectomy can damage the spleen?

A

Splenorenal and splenocolic ligaments

70
Q

Which of the following is true regarding the clinical physiology of the ear?

High frequency waves are detected in the scala tympani

Low frequency waves are detected at the apex of the organ of Corti

The scala media is filled with perilymph

Scala media contains the organ of Corti

Normal hearing frequency ranges from 20-2000Hz

A

Scala media contains the organ of corti.

High frequency waves are detected at the base of the organ of corti

Low frequency waves are detected in the scala tmypani

Scala media is filled with K rich endolymp

Normal hearing frequency ranges from 20-20000 Hz

71
Q

Causes of balanitis

A

Strep infection is the most common cause, though staph can do also

Candida albicans can cause balanitis.

72
Q

Allergy to patent V blue dye used in SLN mapping occurs in what proportion of cases?

A

1%

73
Q

Most common cause of primary hyperaldosternoism?

A

Con’s syndrome

74
Q

?Nerve injury in epidural insertion

What action is most appropriate?

A

MRI spine to show any gross neural damage

Epidural catheter should not be removed until this is done

75
Q

What artery supplies the posterior scalp?

A

Occipital artery

76
Q

What can be used to relocate a posterior hip dislocation?

A

Allis technique

Patient supine and given sedation/general anaesthetic

Flex the hip and knee to 90 degrees and apply longitudinal traction in the line of the femur while an assistant provides counter traction by applying pressure to ASIS

The surgeon than adducts and internally rotates the hip, before extending the hip whilst externally rotating the leg

77
Q

Position of a posteriorly dislocated hip

A

Shortened, flexed, adducted and internally rotated

78
Q

Decorticate posutring

A

Flexion, scores 3

79
Q

Decerebrate posturing

A

Extensions, scores 2

80
Q

Neonates following bowel surgery

A

Often unable to tolerate oral feeds and may thus require parenteral nutrition

81
Q

Rate of feeding in neonates

A

150ml/kg/day

82
Q

Definite indications for splenectomy

A

Primary benign or malignant splenic neoplasm

Splenic abscess

Splenic echinococci cyst

Splenic venous thrombosis with left sided portal HTN and gastric varices

Splenic artery aneurysm

Radical operation for malignant lesion of stomach, tail of pancreas or hepatic flexure

Staging of Hodgkins

Splenic injury not amenable to salvage

83
Q

Why is an impalpable dorsalis pedis pulse not necessarily an indicator of PAD?

A

The artery is absent in 3-10% of population

84
Q

What is an effective way to confrim ?compartment syndrome when there is diagnostic uncertainty?

A

Measure the pressure in each leg and compare values

85
Q

What is the risk associated with human albumin solution?

A

Anaphylaxis

86
Q

What is the mortality associated with an open pelvic fracture?

A

50%

87
Q

Patient presents with penile fracture

If Buck’s fascia remains intact, where will the haematoma be visible?

A

Penile shaft only

88
Q

Meconium should be passed by what point?

A

24h

89
Q

How is oesohpageal cancer staged?

A

EUS and PET scan

Staging laparoscopy is not indicated if the tumour does not involve the GOJ

90
Q

What is seen in an avulsion fracture of the tibial spine

A

Impaired resistance in the anterior translation of the tibia on the femur. i.e. Anterior draw on Lachman’s

The tibial spine is the site of insertion for the ACL

Therefore in the context of a tibial spine fracture, the ACL is likely avulsed

91
Q

Incidentaloma of the adrenal usually represents what?

A

Non functioning adrenal adneoma

92
Q

What is the maximum amount of blood that can be collected for autologous transfusion of pre-collected blood?

A

4-5 units

93
Q

EDH caused by damage to which branch of MMA?

A

Anterior branch

94
Q

In a seriously injured child what is the bolus used?

A

20ml/kg of Ringer’s lactate

95
Q

Pathophysiology of trench foot

A

Disease of the sympathetic nerves and blood vessels in the feet observed when the feet have been wet for a prolonged period of time.

Skin is initially red and progressively becomes pale, mottled and grey or cyanotic.

96
Q

How are bladder lacerations repaired?

A

In layers with absorbable sutures

97
Q

Thompson technique in lymphoedema

A

Excision of subcutaneous tissue and tunnelling of a dermal flap through the fascia into a muscular compartment of the leg

98
Q

Which of the following is a sign of isolated cervical spine injury?

Inability to shrug shoulders

HTN with bradycardia

Grimacing to pain below the clavicle

Diaphragmatic breathing

Unilateral pupillary dilatation

A

Cord injury above T1 will remove intercostal muscle function, as such the sole muscle involved in ventilation is the diaphragm, leading to diaphragmatic breathing.

An injury of the cord above C3 will lead to total diaphragmatic paralysis if the injury is bilateral.

99
Q

What is the necessary size of the patient electrode in monopolar diathermy?

A

70cm^2

100
Q

Use of monopolar diathermy in pacemaker

A

Should be used for <2 seconds and away from site of pacemaker

101
Q

Acid base disturbance in cardiopulmonary arrest

A

Mixed metabolic and respiratory acidosis

102
Q

Comminuted intra-articular fracture to the base of the first metacarpal

A

Rolando’s fracture (Bennett’s is not comminuted)

103
Q

A complete fracture through the femoral neck with rotation of the femoral head within the acetabulum, demonstrating minimal displacement

A

Garden III fracture

104
Q

Brainstem rule of 4s

4 rules

A

4 structures in the midline beginning with M

4 sturcutres to the side beginning with S

4 cranial nerves in the medulla, 4 in the pons and 4 above the pons

The 4 motor nuclei in the midline are those that divide equally in the 12 (except for 1 and 2) i.e. 3, 4, 6, 12

105
Q

What are the 4 medial structures?

A

Motor pathway- corticospinal tract

Medial lemniscus- contralateral dorsal sensation

MLF- ipsilateral INO

Motor nucleus and nerve (3, 4, 6, 12)

106
Q

What are the 4 lateral structures?

A

Spinocerebellar pathway

Spinothalamic pathway

Sensory nucelus of the 5th cranial nerve

Sympathetic pathway

107
Q

4 cranial nerves in the medulla

A

9-12

108
Q

4 cranial nerves in the pons

A

5-8

109
Q

4 cranial nerves above the pons?

A

1-4

110
Q

Medial brainstem syndrome will thus comprise of?

A

4Ms and relevant motor cranial nerves

111
Q

Lateral brainstem syndrome will thus comprise of the

A

4Ss and the relevant cranial nerves

112
Q

If there are signs of both medial and lateral brainstem syndromes, what should be considered?

A

Basilar artery problem

MRCS Part A (15 decks)

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