IGNORE - General EMRCS Questions From MOCKS Flashcards
what is subclavian Steele syndrome
this is where there is proximal stenosis of the sub clavian artery and so you get retrograde flow.
Define a carcinoid tumour
these are neuroendocrine tumours which secrete serotonin. They originate in the neuroendocrine cells in the intestine
Define syringomyelia
a disorder where a cystic cavity forms within the spinal cord.
What muscles of the forearm and hand does the median nerve supply
the flexors + pronator teres +pronator quadratas
LOAF muscles in the hand
- lateral 2 lumbricles
- Opponens pollicis
- Abductor pollicis brevis
- Flexor pollicis brevis
At what site is most dietary iron absorbed?
duodenum
which nerve lies within the carotid sheath
vagus nerve
what is the rule of 2 of meckles
2% of the population
2 years old
2 foot proximal to the ileocecal valve
2 inches long
2 years of ages
2 x as likely in females
2 types of ectopic tissue (Gastric and pancreatic)
define a pleomorphic adenoma
a benign tumour of the salivary gland
what are the contents of the femoral canal
Lymphatic vessels
Cloquet’s lymph node
What are some of the signs and symptoms of sub Flavian Steele syndrome
occurs when increased blood flow to the arm
pre syncope and syncope
neurological insufficiency
BP difference between the arms
at what anatomical level can the renal arteries be found
L2
What hormone decreases appetite?
Leptin
where are you likely to see diverticular disease
common in colon - most common in sigmoid
almost never seen in the rectum
what is the correct invesitation for a suspected lymphoma (clinically enlarged lymph nodes)
Excision biopsy lymph node
What is the treatment of a extra capsular NOF?
intertrochanteric: Dynamic Hip screw
Subtrochanteric: Intramedellary Nail
describe the webber classification
used for fibular fracture:
A: stable and treat with a cast
B: either stable or unstable. If unstable there is taler shift and you need fixation.
C: unstable and needs fixing
what is the Origen of the superior gluteal artery?
aorta –> Common iliac –> Internal iliac –> Superior gluteal
what are the features of a subdural haematoma?
- most commonly occur around the frontal and parietal lobes
- risks include old age and alcoholism
which nerve innervates the head of the triceps
radial
Where are the reticulo-endothelial cells concentrated within the spleen?
white pulp
what is the lymphatic drainage of the testicles
para aortic
what is the tumour marker for breast cancer
CA15-3
what cells are first identified after a splenectomy
reticulocites, target cells and siderocytes
what is the mechanism of action of carbimazole
inhibition of the thyroid peroxidase enzyme
what is diversion proctus
inactive use of bowel e.g. rectal stump after Hartmans
can ulcerate and bleed
T tube is removed and five hours after removal a small amount of bile is noted to be draining from the T tube site. What is the best course of action?
allow to resolve spontaneously
what does a valgus stress test measure
the strength of the medial collateral ligament
what is McMurreys test
this is a test used to evaluate for meniscal injuries
what is the level of the inferior mesenteric artery?
L3
what is the blood supply to the oesophagus
upper third - inferior thyroid
mid third - aortic branches
lower third - left gastric
Which main group of receptors does dobutamine bind to?
B-1
What is meiges disease
a primary lymphedema in the lower limbs (genetic) swelling often begins at the feet and ankles and progresses up the leg.
Onset 1-35 years
what is the treamtent of hypercalcemia
fluids + IV Pamidronate
which cancers are you likely to get if you have a BRCA gene mutation
breast and ovarian cancer
what are morgani hernias
rare congenital hernia
commonly contains the transverse colon
A 55 year old man with a long history of achalasia is successfully treated by a Hellers Cardiomyotomy. Several years later he develops an oesophageal malignancy. Which of the following lesions is most likely to be present?
Squamous Cell Carcinoma
A 4 year old boy has an atalgic gate and an associated recent viral illness. what is the likely diagnosis
transient synovitis (it is associated with viral illness)
where do the intrinsic and extrinsic pathways of the coagulation cascade meet?
at the activation of factor 10
what is a hadfields procedure
total duct excision
what are the components of the rockall score
A: Age
B: Blood pressure drop (Shock)
C: Co-morbidity
D: Diagnosis
E: Evidence of bleeding
Which nerves conveys sensory information from the laryngeal mucosa?
laryngeal branches of the vagus
what nerve is responsible for pronation of the hand
median nerve
During short saphenous vein surgery for varicose veins which of the following nerves is particularly at risk
sural nerve
define minute ventilation
Minute ventilation is the total volume of gas ventilated per minute.
Which cranial nerve supplies the motor fibres of styloglossus?
hypoglossal
which coagulation factors does heparin inhibit?
2,9,10 and 11
what are some of the symptoms associated with Klippel - trenaunay syndrome
- Port wine stains
- hypertrophy of the limbs
- varicose veins
- low flow rates through vascular anomalies
What are the features of Folicular carcinoma and who is it most common in
Most common in Middle Aged people
1. Painless
2. Slow growing
3. single nodule
4. common to have bone metastasis
where is calcium absorbed
small bowel
what hepatobiliary disorders are most classically associated with ulcerative colitis?
Primary sclerosing cholangitis
Which virus is a cause of cervical carcinoma
Hpv 16 and 18
how would you diagnose a scaphoid fracture?
MRI (does not initially show up on x rays)
what decreases secretions in the pancreas
somatostatin
what is abdominal pain + constipation + blue lines on gums + leg weakness a sign of?
lead poisoning
what hormones are increased in stress response I.e. surgery
Adrenocorticotrophic hormone (ACTH)
Aldosterone
Prolactin
Antidiuretic hormone
Glucagon
renin
cortisol
growth hormone
how would you treat an ileo-illial intussusception?
laparotomy
what is bushings triad
Widening of the pulse pressure
Respiratory changes
Bradycardia
what is comedo necrosis
a sign of DCIS
What is the anatomical level of the transplyloric plane
L1
During an Ivor Lewis Oesophagectomy for carcinoma of the lower third of the oesophagus which structure is divided to allow mobilisation of the oesophagus?
azygos vein
what is the treatment of a splenic vein thrombosis
Splenectomy
What is warthins tumours
a benign tumours of the protid gland
What scan would you do if you were concerned about renal scaring
DMSA scan
what structures pass through the supraorbital fissure
LASST:
Lacrimal nerve
Abducens nerve
superior opthalmic vein
Superior and inferior Division of Oculomotor
Trochlear Nerve
Recurrant meningeal artery
A 3 day old baby develops dyspneoa. A chest x-ray is performed and shows a radio-opaque shadow with an air-fluid level in the chest. It is located immediately anterior to the 6th hemivertebrae. what is the likely diagnosis
bronchogenic cyst
A 23 year old man who plays rugby for a hobby presents with recurrent anterior dislocation of the shoulder. Which of the following abnormalities is most likely to be present to account for this?
benkarts lesion
What is TURP syndrome
this is where you get absorbtion of the fluid used to irrigate. you get a decrease in sodium
what is a common complication of splenectomy
the tail of the pancreas can be damaged and lead to the leakage of amylase
What proportion of salivary gland secretions is contributed by the parotid gland?
25%
what is the diagnostic scan unsed to diagnose meckles diverticulum
technetium scan
What is the main event involved in the neovascularization of the immature wound bed following surgery
Endothelial cell proliferation
what the most common type of urethral cancers
90% TCC
why are churns patients more likely to get gall stones?
bile salts are reabsorbed in the terminal ileum
at what level does the spinal cord terminate
L1
at what anatomical location is the ampulla of vata found
medial aspect of the 2nd part of the duodenum
what are the contents of the carotid sheath
Common carotid artery
Internal carotid artery
Internal jugular vein
Vagus nerve
what nerve is at risk of damage during a gastric fundoplication and what are the subsequent effects
Vagus nerve
can lead to delayed gastric emptying
aortic dissection with arotic valve regurgitation signifies a direction where in the aorta
proximal portion
where is the location of the femoral artery
1-2cm inferiorally from the mid inguinal point
define and state the normal value for anatomical dead space with regards to ventilation
Anatomical dead space: 150mls
Volume of gas in the respiratory tree not involved in gaseous exchange: mouth, pharynx, trachea, bronchi up to terminal bronchioles
why do meckles diverticulum bleed
they contain ectopic gastric tissue which commonly ulcerates / perforates
In HIT what blood results would you expect
low platelets
treat with stopping heparin
define adrenaloma
incidental swelling in adrenal gland - treat with
what are some of the tumour markers of non seminomatous germ cell tumours
- AFP elevated in up to 70% of cases
- HCG elevated in 40%
what are curlings ulcers?
acute gastric ulcers associated with severe burns. Causes haematemisis / GI bleeds
what is Fitz Hugh Curtis syndrome
a rare disorder when pelvic inflammatory disease causes swelling around your liver and adhesions to the abdominal wall
what is Perthes disease and how do people present with it
avascular necrosis of the femoral epiphysis of the femoral head
- common I children 2-12 years old
- flattened femoral head
- hip pain
- limp
what is pes anserinus bursitis
swelling over the proximal medial aspect of tibia at the site of insertion of the gracilis, sartorius and semi-tendenous tendons. This is common in young athletes with overuse
A 30 year old male presents with gynaecomastia. Clinically, he is noted to have a nodule in the left testis. What is the most likely diagnosis?
leidig cell tumour
What does the glossopharyngeal nerve supply?
Motor: stylopharyngess muscle, parotid gland
sensory: posterior third of the tongue, pharynx, tympanic cavity
which cell type proliferation causes graft vs host disease
lymphocyte
in a patient who has developed diplopia with raised ICP which nerve is most likely to be affected
abducens
which areas of the body are the highest levels of potassium found
the rectum
what nerve is commonly injured in a hernia repair which was cause sensation loss to the inner thigh
ilioinguinal nerve
what is the treatment of a thyroglossal cyst?
excision of cyst + resection of tract + wedge of hyoid + wedge of tongue muscle behind hyoid
Which nutritional deficiency is most likely to be implicated in poor collagen formation as the wound heals?
vitamin C
Vitamin C is involved in the cross linkage of collagen and impaired wound healing is well described in cases of vitamin C deficiency.
what is osteomalacia and what blood results are diagnostic
low bone mineralisation due to low vitamin D
- low calcium
- low vitamin D
what is a xenograft
tissue transplanted from another species
what clotting factors does DIC affect
Factors 1,2,5,8,11
what structures are found in the posterior triangle of the neck?
Muscles:
- Inferior belly of omohyoid
- Scalene
Nerves:
- Accessory nerve
- Phrenic nerve
- Three trunks of the brachial plexus
- Branches of the cervical plexus: Supraclavicular nerve, transverse cervical nerve, great auricular nerve, lesser occipital nerve
Vessels:
- External jugular vein
- Subclavian artery
A 32 year old male is receiving a blood transfusion after being involved in a road traffic accident. A few minutes after the transfusion he complains of loin pain. His observations show temperature 39 oC, HR 130bpm and blood pressure is 95/40mmHg. what is the diagnosis and what is the test used to confirm this
ABO Incompatability
Coombes test
which cells release gastric acid
parietal cells
what are some of the features of nephroblastomas
Renal cancers that occur in the first 4 years of life
associated with haematuria
metastasise early
what would pain in the anatomical snuff box indicate
scaphoid fractures
what is the treatment f bile duct injury as an operative complications
If the operating surgeon does not regularly practise this type of surgery then the area should be drained and the patient transferred to an HPB unit.
what nerve is responsible for voluntary control of the bladder
pudendal nerve
in healing of a fractured bone, when would you expect to be bale to see fracture callus on an xray
3 weeks
what are the key features of SCC of the oesophagus
History of progressive dysphagia. Often signs of weight loss. Usually little or no history of previous GORD type symptoms.
what are Desmond tumours
tumours of connective tissue
Through which of the foramina does the genital branch of the genitofemoral nerve exit the abdominal cavity
deep inguinal ring
what is poorly reabsorbed following gastrectomy
B12
what is the cause of osteopetrosis
defective osteoclast function resulting in failure of normal bone resorption
what vascular structure lies inferior to the trunk of the facial nerve
retromandibular vein (formed by the joining of the maxillary and superficial temporal vein)
what causes secretions of water and electrolytes in the pancreas
secretin
what would a pulitile mass be in an IDVU
false aneurysm
is the intrinsic or the extrinsic pathway in coagulation the main pathway?
extrinsic is the main pathway
what is commonly the case of confusion in a patient with breast cancer
hypercalcaemia (boney metastasis)
what are some of the features of ACL rupture
- caused by large twisting force applied to bent knee
- Rapid knee swelling
- load crack heard
What are the treatment options for pancreatic cancer?
Head of Pancreas: Whipples resection.
Carcinoma of body / tail: poor prognosis, distal pancreatectomy if operable
Likely to have adjacent chemotherapy
ERCP and stent for jaundice and palliation.
What is pagets disease and what blood tests are diagnostic
bone density is low followed by sclerosis + laying down of weak bone
(BOWED LEGS)
- increased ALP is diagnostic.
- Calcium and Phosphate are normal
when would you stop unfractionated heparin pre operatively
it should be out of the system in 2 hours so stopping 6 hours before should be fine
What pressures are diagnostic of compartment syndroe?
> 40mmHg
where does the trachea bifurcate
T5
what are the pre requisites for bariatric surgery
All non-surgical measures have failed to achieve or maintain adequate clinically beneficial weight loss for at least 6 months.
Will receive intensive specialist management
They are generally fit for anaesthesia and surgery
They commit to the need for long-term follow-up
First-line option for adults with a BMI > 40 kg/m2 in whom surgical intervention is considered appropriate; consider orlistat if there is a long waiting list. OR 35-40 with other significant disease
what nerve innovate the gluteus Maximus
inferior gluteal nerve
what score is used for the histological grading of prostate cancer?
Gleason score
what structures pass through the infraorbital fissure
inferior opthalmic vein
maxillary nerve
zygomatic nerve
Which virus is associated with Kaposi’s sarcoma?
Herpes virus 8
What are the structures in the porta hepatis
Portal vein
Hepatic artery
Common hepatic duct
what is Courvoisiers law
The development of jaundice in association with a smooth right upper quadrant mass is typical of distal biliary obstruction secondary to pancreatic malignancy
where is the musculocutaneous nerve located
between the biceps brachii and the brachialis
what are the common features of intersussception
The child often has a history of being unwell for one to three days prior to presentation. The child may pass bloody mucus stool, which is a late sign. Examination of the abdomen is often normal as the sausage mass in the right upper quadrant is difficult to feel
What is the Pathological significance of the femoral canal
As a potential space, it is the site of femoral hernias. The relatively tight neck places these at high risk of strangulation.
what are key features of peptic strictures
Longer history of dysphagia, often not progressive. Usually symptoms of GORD. Often lack systemic features seen with malignancy
what are the two sub types of germ cell tumours in testicular cancer
- seminoma
- non seminomatoes germ cell tumours (Teratoma, yolk sac tumour, mixed germ cell, choriocarcinoma
What is the treatment of a pleomorphic adenoma
superficial paraotidectomy
what is the treatment of hepatocelular adenomas
surgical resection as they have a high chance of malignant trasnformation
what is the cellular change in barats oesophagus
squamous to columnar
What is filariasis
a secondary lymphedema.
this is a disease where adult worms live in the lymphatic system spread by mosquitoes. You get lymphedema and elephantiasis and hydroceles in men
In which conditions is a Ghon complex most likely to be found?
TB
what structure is inclose proximity to the deep ring
inferior epigastric artery (laterally) and vein (medially)
Which nerve supplies the lateral aspect of the palm
The median nerve
what are the borders of the femoral canal
Laterally: Femoral vein
Medially: Lacunar ligament
Anteriorly: Inguinal ligament
Posteriorly: Pectineal ligament
what is the function of the obtuator nerve
sensation to medial aspect of the thigh
adduction and internal rotation of thigh
what muscles does the median nerve supply in the forearm
Pronator teres
Pronator quadratus
Flexor carpi radialis
Palmaris longus
Flexor digitorum superficialis
Flexor pollicis longus
Flexor digitorum profundus (only the radial half)
what is the blood supply to the lacrimal apparatus
ophthalmic artery
who does the Monroe-Kelly Doctrine not apply to
children with unfused fontanelles
what would damage to the superior laryngeal nerve cause and what muscle would also be affected?
inability to sing high notes
crycothyroid muscle would also be affected
Which syndrome listed below may be present in a patient with multiple intestinal hamartomas and pigmentation spots around the mouth
PJS
what eye signs do you get in osteogenesis Imperfecta
blue sclera
in appendicitis, at what location in the RIF is the appendix likely to be found
retrocecal
where are gastrinomas most commonly found?
duodenum, pancreases, stomach
which clotting factors are most sensitive to temperature
V and VIII
what are charcots triad
jaundice, fever, RUQ pain
what is the name given to a sebum filled lesion surrounded by the outer root sheath of a hair follicle
pilar cyst
what are some of the features of chrons disease?
- Mouth to anus
- Cobblestone appearance macroscopically
- transmural inflammation
- patchy distribution (non continuous)
- granulomas seen histologically
what are some of the symptoms of a prolactinoma?
gyncocomastia, visual disturbances, nipple discharge
what type of tumour is a carotid body tumour
pvraganglionoma
what is achondroplasia
dwarfism (caused by defects in fibroblast growth factor receptor)
which vitamin is involved in the formation of collagen
vitamin C
What is the blood supply of the ureters
Upper third = renal arteries
Middle third = common iliac
Lower third = gonadal arteries
what is the likely diagnosis for a hyperchoic lesion on liver USS with a normal AFP
haemangioma
how do you calculate the anion gap?
(sodium + potassium) - (bicarbonate + chloride)
what is a bockdalek hernia?
a congenital hernia
commonly involves the left hemidiaphram
commonly contains stomach or kidney
at what age should children with otherwise uncomplicated umbilical hernias be considered for surgery?
3 years or older
many close within the first year of life