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MRCS Past Questions Knowledge > Extras > Flashcards

Extras Flashcards

1
Q

Aetiology of RTA?

A

Pre renal hypoperfusion
Drugs- gentamicin
Rhabdo- myoglobin
ACEi/NSAIDs

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2
Q

Effects of AL and AA amyloid?

A

AL- nephrotic syndrome, restritive cardiac disease, GI bleeding
AA- hepato/splenomegaly, nephrotic syndrome

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3
Q

Where do you find isolated Amyloid deposits?

A

Thyroid
Renal Tract
Aorta

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4
Q

Renal stones management?

A 
A2E, MDT
C- watch and wait + analgesia if <4mm
S- ESWL if <2cm and visible on KUB
Renal ureteroscopy + stent
PCNL
Open
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5
Q

Causes of ED?

A 
Neuro- spine/neuropathies/DM
Cardiac- PVD
Endocrine- hypothyroidism, hypongonadism
Meds- antidepressant, anticholinergics, anti androgens, antipsychots
Pscyh
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6
Q

Risk of AAA surgery?

A

MI/distal thromboembolism
Renal/colonic ischaemia
Graft infection, thrombosis, endo leak
Adhesions/fistula

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7
Q

When should varicosities have surgical fixation?

A

If skin comprimise or IR failure

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8
Q

When to go for open and lap hernia repair?

A

Lap hernia repair- equal complication and failure rates to open, quick return to work
Open- can be done under LA, no pneumoperitoneum

Worth operating as 0.3-3% complication rate => complications lead to 5% operative mortality/morbidity

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9
Q

Stoma complications!!!

A

Stoma related- prolapse, stenosis, retraction, skin effects, hernia
General- high output, stones, short gut syndrome (fluid/electrolyte imbalances)

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10
Q

Hyperthyroidism management and when for surgery?

A

MDT
M- carbimazole- treats hyperT, Propanolol- controls sympts
Radioactive iodine- if MNG/grave’s
Surgery- if relapsing to medical/DTx/large goitre-cosmetic/air way obstruction

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11
Q

Consequence not to forget of respiratory diseases/COPD?

A

Cor Pulmonale!!!

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12
Q

Operative risks of COPD

Work up to do to minimise risks?

A

Poor lung function, increased infection risk, on steroids, cor pulmonale?

Atelectasis leading to pneumonia
Poor cough
Decreased ventilatory drive
Aspiration risk

Work them up!!
Stop smoking and optimise medication
Regional A
Early mobilisation
Sit up early
BiPAP/HDU bed
Analgesia
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13
Q

When to op for cold vs hot cholecystectomy

Abx for cholecystitis

A

Hot if <72 hours of sympt- adhesions not formed by then
However, technically a lot more difficult
Make sure to do intra op cholangiogram

Cold 6-8 weeks later, once inflammation subsided

Abx- co-amox/cephalosporin +- met

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14
Q

Aetiology of post op fever?

A 
Wind- PE/pneumonia
Water- UTI
Wound- SSI
What did we do- anastomotic leak
Pancreatitis
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15
Q

Management of anastamotic leak?

A 
A2E
Abx
NBM + fluids/TPN
CTAP
R/O other causes
Prep for op
Escalate

Op- washout/resection/stoma

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16
Q

Definition of critical limb ischaemia?

A

ABPI <0.4

Rest pain/ulceration/necrosis/gangrene

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17
Q

How to complete vascular exam?

A 
ABPI/BP
Doppler
Arterial Duplex
Fundoscopy
Urine dip
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18
Q

Investigation and treatment of sialolithasis?

A

Ix- US, sialogram, CT
Rx- C- lemon drops, good hydration, good oral hygiene, massage
M-abx
S- sialogram/lay open duct/remove gland

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19
Q

Gynaecomastia DDx?

A 
Physiological- Old age/puberty
Think reduced testosterone
Testicular atrophy
Renal disease
Chemo
Finasteride
Kleinfelters
Increased oestrogen
Prolactinoma
Leydig cell tumour/testicular tumour
Breast Ca
Adrenal tumours
Medications- spiro/antipsychotics
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20
Q

IBS treatment?

A

R/o other causes
Dietician
Fibre
Buscopan- antispasmodics

21
Q

Management of chronic pancreatitis?

A

Stop alcohol
Good analgesia
Good nutrition- pancreatic enzyme supplements (creon), avoid fats, vitamins
Surgically- remove stone blockage/masses blocking

22
Q

Bladder cancer management?

A

Stage
MDT
Intravesical BCG/chemo
DTx/Chemo

S- TURBT/Radical

23
Q

PE management?

A

Massive vs non massive
Massive- thrombolysis-ALS, embolectomy for saddle?
Non massive- trust, LMWH
Convert to warfarin/NOAC for 3/6 months

24
Q

ECG findings on PE?

A

Sinus tachy

S1Q3T3

25
Q

NCEPOD statuses?

A 
1a- Life threatening
1b<6hours
2<24hours
3<7 days- expedited
4- elective
26
Q

Management of carpal tunnel?

A 
Exclude underlying causes- fluid retention, neuropathies-DM, Neck/proximal, thyroid
C- night splinting for at least 3 weeks
M- steroid injections/WHO
EMG/Nerve conduction
S- carpal tunnel release
27
Q

Role of angiotensin II?

A

Vascoconstriction/SNS activation
Aldosterone/ADH release
Na/H20 reabsorption, K excretion

28
Q

RA pathophys?

A

Autoimmunitiy leading to acute inflam in joint
Synovitis
Damage

29
Q

Ix and Management of RA?

A 
Rf and anti- CCP
C- physio, exercise, warm packs
M- DMARDs- metho, sulfas, infliximab
Steroids for acute flares
S-athroplasty
30
Q

Pathophys of boutonnieres/swan necking?

A

Boutonierre’s rupture of central slip on extensor surface

Swan necking- rupture of volar plate

31
Q

TPN indications?

A

GI- short gut syndrome, IBD, fistula, radiation enteritis, bowel rest
Systemic- burns, 10% body weight loss, trauma, sepsis +MOF

32
Q

Why not too much glucose in TPN?

A

Glucose leads to oxidation which leads to CO2=> resp failure
Hyperglcaemia bad in acutely unwell
Fatty liver
Fatty acid deficiency

33
Q

How to test level of epidural block

A

Ice packs- temp first to be affected

34
Q

Difference between spinal cord lesions?

A

Ant cord- ant spinal artery ischaemia
Bilateral loss of motor pain/temp/sensation. Intact vibration/proprioception

Brown sequard- contraL pain/temp, IpsiL paralysis/vibration/proprioception

Central cord
Sensory and motor deficit- upper more than lower
Hyperextension injuries in elderly

35
Q

Causes of metabolic alkalosis?

A 
Vomiting/Diarrhoea
GOO
Diuretics
Conns
Barrter's
Bicarb infusion
36
Q

How to calculate HR in ECG

A

300/large squares between QRS

6 x total number in strip

37
Q

How is CO2 transported in blood?

A

Dissolved
Buffer system
Bound to Hb

38
Q

What is the chloride shift?

What is the counter current mechanism in kidneys?

A

Chloride- Cl- shifted into RBCs to maintain cellular electrical charge, exchanged with bicarb
Controls Hb affinity for O2

Counter current- thin descending limb in permeable, thick ascending is impermeable
Enables generation of osmotic gradient for water reabsorption/concentration of urine

39
Q

DIC bloods and how to treat?

A

Low Fibrinogen and platelets, raised D dimer and APTT/PT

FFP, Cryo, platelets

40
Q

ARDS treatments?

A 
Treat underlying causes
Ventilate and oxygenate
Consider proning
ECMO
Steroids/ABx- varying success
TPN- optimise nutrition
41
Q

Role of thyroid hormone?

A

Increased growth and metabolism

Increase sensitivity to adrenaline

42
Q

Pulmonary oedema management?

A 
A2E
Oxygen
Sit up
Morphine to help V/Q matching
GTN infusion
IV furosemide
ITU- dialysis/ventilation
43
Q

What is preload?

Starlings law?

A

Preload is equal to the end diastolic volume
Pre load proportional to afterload
Mycocardial contractility preportional to stretch

44
Q

Management of enterocutaneous fistulas?

A 
A2E/MDT
SNAP
Sepsis- treat
Nutrition + fluids + electrolytes
Anatomy- define
Protect skin
Plan

Surgical role is to treat infection and distal obstruction

45
Q

Rhabdo causes and treatment?

A 
Burns
Crush
Reperfusion
Trauma
Hypothermia
A2E
Aggresive rehydration
Forced diuresis
Alkalinisation of urine
Treat hyperkalaemia- calcium gluconate
46
Q

Role of HCL?

A

Activates pepsinogen to pepsin- breaks down proteins

Antimicrobial

47
Q

How does NSAIDs lead to peptic ulcers?

A

Irritate mucosal lining
Reduce blood supply to mucosa
COX inhibitors leading to decreased prostogladin production leading to less mucous secretion

48
Q

What does TIPSS stand for?

A

Transjugular intrahepatic portosystemic shunt

49
Q

Why raisd platelets in acute bleed?

A

Dehydration

Acute phase reactant to acute inflamm

MRCS Past Questions Knowledge (6 decks)

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