Chat GBT and past qs doc Flashcards
Which structure is most at risk in thoracocentesis?
Intercostal nerve
Intercostal bundle runs VAN (vein, artery, nerve) below the rib
Therefore, the nerve is lowest so most vulnerable
What is the mechanism of action of heparin?
Antithrombin III enhancer
Heparin binds to and enhances antithrombin III
This inhibits thrombin (factor IIa) and factor Xa, reducing clot formation
What is the first antibody produced in the primary immune response?
IgM
Forms pentamers and effective at agglutination and complement activation
Name the mneumonic and organs that are intraperitoneal?
SALTD SPRSS
Stomach
Appendix
Liver
Transverse colon
Duodenum (first part only)
Small bowel (ileum and jejunum)
Pancreas (tail only)
Rectum (prox 1/3)
Sigmoid colon
Spleen
Name the retroperitoneal mneumonic and structures?
SAD PUCKER
Suprarenal (adrenal) glands
Aorta and IVC
Duodenum (2nd, 3rd, 4th parts)
Pancreas (head, body, tail)
Ureters
Colon (ascending and descending)
Eosophagus
Rectum (distal 2/3)
Name the compartment and muscles within the compartment innervated by the femoral nerve?
Anterior thigh muscles
Vastus medialis
Vastus lateralis
Vastus intermedius
Rectus femoris
Name the compartment and muscles innervated by the sciatic nerve in upper thigh?
Posterior compartment of thigh
Hamstrings
-Biceps femoris
-Semimembrenosus
-Semitendinosus
-Adductor magnus
Name a selective COX-2 inhibitor?
Celecoxib
It is designed to reduce inflammation without affecting gastric mucosa
Aspirin, ibuprofen and naproxen are all non-selective
Failure of what embrylogical development results in congenital diaphragmatic hernia?
Failure in Pleuroperitoneal membrane development
Compare the nerves that innervate the muscles of facial expression and muscles of mastication?
Facial expression = facial nerve
Muscles of mastication = CN V3 - mandibular branch of trigeminal nerve
Which hormone secreted by the duodenum stimulates pancreatic secretion of bicarbonate?
Secretin
Inhibits gastric acid secretion at the same time
Which local anaesthetic has the longest duration of action?
Bupivacaine
Lidocaine is shorter acting
Which 2 cytokines are responsible for fever onset in inflammation?
IL1 - the main one
IL6
Failure in which embrylogical development results in Hirschprung’s disease?
Neural crest migration failure
Name one partial U-opioid receptor agonist?
Buprenorphine
Morphine and fentanyl are full agonists, codeine is a weak but full agonist
Which anaesthetic gas has rapid onset and recovery?
Desflurane - it has low blood-gas soluability
Sevoflurane is intermediate
From which ring does the ilioinguinal nerve enter the inguinal canal?
Superficial ring
Spermatic cord enters via deep ring
Describe the differences between septum transversum and pleuroperitoneal folds?
Septum transversum - forms the central tendon of diaphragm, carries the phrenic nerve. An initial partition between thoracic and abdominal cavities
Pleuroperitoneal folds - close the pericardioperitoneal canals and fuses with septum transversum
Defect in pleruoperitoneal folds results in congenital diaphragmatic hernias
What nerve roots (and nerve) supply diaphragm?
Phrenic nerve - C3,4,5
C3,4,5 cos thats the embryological origin of the diaphragm
What is the mechanism of action of macrolides and tetracyclines?
Inhibit protein synthesis
What is the mechanism of action of quinolones, metronidazole and trimethoprim?
Inhibit DNA synthesis
What is the mechanism of action of penicillins and cephalosporins?
Inhibit cell wall formaiton
In submandibular gland excision, which structure lies most superficial?
Facial vein
Lingual nerve and hypoglossal nerve lie deep to the gland so are encountered later
Most important structure in supporting the uterus?
Central perineal tendon
What is the commonest extra colonic lesion to occur in FAP?
Duodenal polyps
What is the best local anaesthetic to use for a beirs block?
1% prilocaine
Less cardiotoxic so used in IV local anasthesia (beir’s block) for distal limb operations
What is the pattern of inheritance in an AD dominant disease?
50% chance of it being passed on
What condition arises due to defect in the neural tube fusion at the caudal end?
Spina bifida
In primary hypertension, which substance is most likely to be elevated?
Aldosterone
(Conn’s syndrome = hyperaldosteronism - raised aldosterone, low renin)
Which phase of wound healing involves granulation tissue formation and angiogenesis?
Proliferative wound healing
Follows inflammatory phase and sets stage for tissue regeneration
Name the 4 aspects involved in the surgical stress response?
Increased cortisol
Increased catecholamines (dopamine, adrenaline)
Increased ADH
Increased glucagon
Reduced insulin sensitivity (this and increased glucagon leads to hyperglycemia)
What 2 substances are mainstay in treating DIC?
Cryoprecipitate - replaces fibrinogen
Fresh Frozen Plasma - replaces clotting factors
In DIC, what would prolonged PT and APTT indicate transfusion of?
Fresh Frozen Plasma
Cryoprecipitate indicated if Fibrinogen <1.5
Deficiency of which vitamin/mineral is most associated with impaired wound healing?
Vitamin A - is essential for collagen synthesis and epithelial repair
For pure collagen synthesis, vit C is most important
What condition causes microvascular bleeding with normal APTT, PT and platelet count?
von Willebrand factor
There is a deficiency in platelet adhesion, no issue with the quantity of them
The defect is with von willebrand factor, which allows the platelets to stick to the exposed collagen
What is deficient below the level of the arcuate line?
The posterior rectus sheath
Where in the GIT is most water absorbed?
Jejunum and ileum
In the kidney, most water is absorbed in proxmial convoluted tubule
Describe calcium , phosphate and ALP levels in osteomalacia?
LOW calcium and phosphate
HIGH ALP
Osteomalacia mostly due to vit D deficiency
Translucent bands seen on XR
Which 2 clotting factors are most susceptible to temperature changes?
Factor 5 and 8
This is why FFP is frozen so soon after collection
Which immunoglobulins are involved in hyperacute graft rejection?
IgG
Hyperacute graft rejection is due to preexistent antibodies to HLA antigens so IgG mediated
Through which foramina does the genital branch of the genitofemoral nerve exit the abdominal cavity?
Deep inguinal ring
Supplies skin and fascia of scrotum
Why should a miller cuff be used when doing a PTFE graft in distal anastamoses?
Use of a Miller Cuff with PTFE reduces the risk of neo-intimal hyperplasia
Especially in distal bypasses
What is the usual outcome measure in a cohort study?
Relative risk
What is the usual outcome measure in a case-control study?
Odds ratio
What does angiogenesis occur as a result of during wound healing?
Endothelial cell proliferation
Name the innervation of the anterior and posterior belly of the digastric muscle?
Anterior belly = mylohyoid
Posterior belly= facial nerve
Nerve supply to external ear?
Auriculotemporal nerve
A branch of CN V2
Which nerve passes through the inguinal canal in both males and females?
Ileoinguinal nerve
Name the only muscle of the tongue which is not innervated by the hypoglossal nerve?
Which nerve is it innervated by instead?
Palatoglossus
Innervated by vagus nerve
Name the only muscle innervated by the external/superior branch of the laryngeal nerve?
Cricothyroid
All other muscles in the larynx innervated by the recurrent (inferior) laryngeal nerve
Compare the nerve that runs within the spermatic cord and the nerve that runs on anterior aspect?
Nerve running within spermatic cord = genital branch of genitofemoral nerve
Nerve running on anterior aspect of spermatic cord = Ileoinguinal nerve
Name the structure that enters the inguinal canal via deep inguinal ring in males and the structure in females?
Spermatic cord in males
Round ligament in females
The ileoinguinal nerve pierces abdominal wall more medially to enter the inguinal canal
The superficial inguinal ring is an opening in which structure?
The external oblique aponeurosis
Which muscle contributes to the cremasteric muscle?
Internal oblique muscle
Innervated by the genital branch of genitofemoral nerve
The aponeurosis of which 2 muscles form the conjoint tendon?
Aponeurosis of internal oblique and transversus abdominus muscle
Where does spironolactone act in the kidney?
Distal convoluted tubule
What passes through the quadrangular space with the axillary nerve?
Posterior circumflex humeral vessels
Which ligament contains the artery supplying the head of femur in children?
Ligamentum Teres
Runs from acetabular notch to the fovea
Which local anaesthetic is most commonly used in a beir’s block ?
Prilocaine
It can be reversed by IV methylene blue
Which CF is synthesized in the endothelial cells of the liver rather than the liver itself?
CF VIII
Therefore less prone to effects of hepatic dysfunction
Which component of the RAAS will be first to be released following drop in BP?
Renin
Drop in BP sensed by the juxtaglomerular cells in the kidney, causing renin secretion
Name the CNs involved in the efferent and afferent pathway of the corneal reflex?
Afferent pathway = ophthalmic branch of trigeminal nerve
Efferent pathway= facial nerve
Why would chorda tympani not be affected by facial nerve injury during parotidectomy?
It branches from facial nerve inside facial canal (prior to parotid)
Which foramen does the facial nerve pass through?
Stylomastoid foramen
With tympanic cavity anterior and mastoid antrum posterior
What will hypercapnia cause in the cerebral perfusion?
Cerebral vasodilation
This will increase intracranial pressure§§
Reflexes involved in ankle reflex?
S1 and S2
Which nerve may be compressed by large pelvic tumours and cause medial thigh pain?
Obturator nerve
Which is the only muscle of the anterior upper arm to insert onto the ulna?
Brachialis
Biceps and brachioradialis insert onto radius (so does supinator and pronator quadratus)
Nerve most commonly encountered in level 1 axillary node clearance?
Intercostobrachial nerve
Which muscle is attached to anterior aspect of the fibrous capsule that encases elbow joint?
Brachialis muscle
When it contracts, it helps to flex the elbow joint
Which amino acids are catecholamines derived?
Tyrosine
Gives rise to dopamine which is modified to noradrenaline and adrenaline
What cells of the adrenal medulla secrete catecholamines?
The chromaffin cells of adrenal medulla
What is measured to obtain renal plasma flow?
Para-amino hippuric acid (PAH)
What is the only muscle to arise from the dorsum of the foot?
Extensor digitorum brevis
Innervated by deep peroneal nerve
Which is the only muscle of the rotator cuff that inserts onto the lesser tuberosity?
Subscapularis
The remainder insert onto the greater tuberosity
Compare the drainage of lymph in the upper and lower ureters?
Upper ureters = para aortic LNs
Lower ureters = common iliac LNs
What nerve innervates platysma?
Cervical branch of facial nerve
Which part of the kidney is responsible for reabsorbing up to 2/3 of filtered water?
Proximal convoluted tubule
Also the site of glucose reabsorption via SGLTs
What 2 structures form the spinous process of the vertebrae?
2 laminae posteriorly combine to form the spinous process
What is the lymphatic drainage of the female urethra?
Internal iliac nodes
Which vertebral level does the inferior thyroid artery enter the thyroid gland?
C6
At the level of the cricoid cartilage
Compare the difference in location of a homonymous hemianopia and bitemporal hemianopia?
Homonymous hemianopia = optic tract
Bitemporal hemianopia = optic chiasm
What is the first line treatment for anal cancer?
Radical chemoradiotherapy
It is first line treatment, compared with rectal cancer, where 1st line treatment is abdominoperineal excision of anus and rectum
Compare the timeframes for post transplant virus infections?
CMV - 4 weeks to 6 months post transplant
EBV - >6 months post transplant. Associated with high dose immunosuppressant activity
Is serotonin a vasoconstrictor or vasodilator?
It is a vasoconstrictor
But, it can cause vasodilation in healthy tissues but causes vasoconstriction in cardiac ischaemia
Which thyroid lesion causes low TSH and a hot nodule?
Toxic adenoma
What is the commonest extra colonic lesion seen in FAP?
Duodenal polyps
Gastric fundal polyps are second most common
Compare what the right and left laryngeal nerves loop under before ascending back up to the larynx?
Right RLN - right subclavian
Left RLN - arch of the aorta
Left RLN is more vulnerable during thoracic surgeries
What endocrine condition can cause osteopenia in a young male?
Hyperparathyroidism
Well circumscribed lucent areas may be seen
Name the testicular tumours that cause raised:
1. AFP
2. b-HCG
3. Oestrogen
raised AFP = yolk sac
BHCG= choriocarcinomas
Oestrogen = leydig cell tumours
What is a relative contraindication to epidural anaesthesia?
What would be a better form of analgesia if epidural contraindicated?
Active infection
(ie- severe appendicitis)
Patient controlled analgesia
In a post op patient given intra op heparin, what does a combination of low platelet count and raised FDP indicate?
DIC
DIC is most likely when low platelet count and raised FDP
Which breast cancer is associated with pronounced lymphocytic infiltrate?
Medullary breast cancer
Marked lymphocytic infiltrate
What is the hormonal antagonist to insulin?
What is it released from?
Glucagon
Released from alpha cells of islets of langerhans
Results in increased plasma glucose levels
What is the earliest phase of wound healing to occur immediatley following surgery?
What is the second phase of wound healing?
Platelet degranulation
It is the earliest phase and results in haemostasis
Neutrophil infiltration is the second phase
Which substance related to thyroid function has its effects mediated by a nuclear receptor?
Triiodothyronine (T3 and T4)
They act through a nuclear receptor mechanism
TSH works via a GPCR
What makes the maxillary sinus particularly prone to infection?
Poor drainage of maxillary sinus due to position of its ostium
The ostium is higgh on the medial wall of the sinus, so secretions can easily pool - leading to stasis and infection
What is the characteristic skull XR finding on multiple myeloma ?
Multiple punched out LYTIC lesions
Bone destruction by increased osteoclast activity
What explains dark urine and pale stool in a pateint with hepatic obstruction?
Increase in conjugated bilirubin being excreted via kidneys
Backflow of conjugated bilirubin which is then excreted via kidneys, causing dark urine and pale stool
What does the liver do to bilirubin?
Turns conjugated bilirubin –> unconjugated bilirubin (water soluable, excreted into GIT)
Nerve root responsible for ankle jerk reflex?
S1 and S2
Which nerve root gives sensory innervation to lateral aspect of foot?
S1
L5 gives sensory innervation to dorsal surface of foot
Name the origin and insertion of psoas major? What action does it have?
Origin = T12-L5 vertebral bodies
Insertion = Lesser trochanter of femur (as ilopsoas muscle- it fuses with illiacus)
Action - hip flexion
Name 4 hip flexor muscles?
Ileopsoas
Sartorius
Rectus femoris
Tensor fasciae lata
Name 2 hip extensors?
Glut major
Hamstrings (bicep femoris, semitendinosus, semimembranosus)
Which artery does the vertebral artery arise from?
Subclavian artery
Below the arcuate line, what does the rectus muscle sit directly on?
The transversalis fascia
“MALT”
There is no posterior aponeurosis below the arcuate line
What does warfarin inhibit?
Prothrombin - it is vit K dependant
NOT antithrombin
What breast condition presents with recurrent abscesses and squamous metaplasia of the lactiferous ducts on histology?
Subareolar abscess
Young smoking women
Which lesion classically contains connective tissue, mature cartilage and ciliated epithelium?
Hamartoma
A benign lung tumour made up of normal but disorganised lung tissues
What is the main collateral supply to the IMA territory and would be required if the IMA was occluded?
Middle colic artery
Its a branch of the SMA but connects with branches of IMA to ensure perfusion of left colon
Name the 3 CNs that may be compressed by cerebellopontine angle tumour?
Facial nerve
Vestibulocochlear nerve
Trigeminal nerve (less common than the other 2)
ED following rectal tumour resection is most likely due to injury of what?
Injury to pelvic splanchnic nerves (S2-S4)
They give parasympathetic nerve supply to the erectile tissue
Compare the antibodies and timeframes involved in hyperacute and acute organ transplant rejection?
Hyperacute rejection = hours/days - IgG mediated
Acute rejection= 2-6 weeks - T cell mediated
What does rapid gastric emptying in dumping syndrome cause?
Hypoglycemia - rapid gastric emptying causes excessive insulin release
Name the 2 effects that epinephrine has on glucose levels?
Stimulating glycogenolysis and gluconeogenesis
Which nerve root is responsible for great toe extension?
L5
Weakness of extensor hallucis longus muscle
Where is Vit K mainly absorbed?
Jejunum and ileum
Which receptors does noradrenaline work on?
Alpha 1 receptors
Compare the 2 CNs most commonly found in the midbrain with the 2 CNs most commonly found in the pons?
Midbrain = CN 3 & 4
Pons = CN 6 & 7
Which ligament tethers the spleen to the posterior abdominal wall?
Lienorenal ligament
Connects spleen to left kidney and posterior abdominal wall
What vertebral level does conus medullaris occur?
L1/L2
L3/L4 is the roots of the cauda equina
Compare what hormone levels are raised in seminomas and teratomas?
Seminomas = hCG
Teratomas = AFP
Which breast lesion shows apocrine metaplasia, epithelial overgrowth and papillary projections?
Benign breast cyst
Describe the location of the ulnar nerve with respect to the brachial artery in the cubital fossa?
Ulnar nerve is medial to brachial artery
Both ulnar and median nerve are medial to the brachial artery, but the ulnar nerve lies deeper to the median nerve
At what vertebral level does the umbilicus sit?
T10
What is the chronological sequence of Ig’s in infection?
IgM first, then IgG
Which nerve root provides dorsiflexion and sensation to dorsum of foot?
L5
S1 is plantar flexion and sensation to lateral foot
Which brachial plexus injury can also result in Horner’s syndrome?
C8-T1 lower trunk injury (Klumpke’s palsy)
Pancoast tumour can also cause Horner’s syndrome
Where do the sympathetic fibres leave the spinal cord?
T1 nerve root
Which nerve passes posterior to the lateral malleolus?
Sural nerve
Supplies sensory innervation to posteriolateral leg
Saphenous supplies medial leg
Superficial fibular supplies anterior leg
What vertebral level is the stellate ganglion located?
C8-T1 level - at the level of the first rib
Injury to the Stellate ganglion can cause horner’s syndrome
What structures lie medial and lateral to the ischiorectal fossa (a common site for abscess)?
Medially = levator ani muscle
Laterally = obturator internus muscle
Abscess can spread from anal canal or rectum
What is the lowest part of the peritoneal cavity when patient is lying flat?
Hepatorenal pouch (morrisons pouch)
It is the space between right kidney and liver and first place fluid accumulates in supine position
Granulomatous tissue on biospy is indicative of which GI disease?
Crohns disease
Diarrhoea can be bloody
UC causes ulceration and crypt abscesses on histology
