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
in a child with a smooth swelling in the RIF, what would the diagnosis be
mesenteric cyst
what 2 features are associated with hepatocellular carcinoma
raised AFP and alcohol use
what are the treatment options for oesophageal cancer
if non metastatic, proximal lesions - normally oesophagetcomy. distal 1/3 normally Ivor-lewis resection.
what is the most common type of cancer of the pancreas?
Adenocarcinoma
What is median arcuate ligament syndrome?
the median arcuate ligament attaches forms at the base of the diaphragm (where aorta perforates the diaphragm) . here it is lower than normal and causes compression of the celiac trunk causing mesenteric ischaemia post prandially
in a patient with ITP, when is the ideal time for platelet transfusion
after ligation of the splenic artery intraoperatively
what muscles are being tested in the trendelenburgs test
gluteus medius and minimus
where is secretin released from
duodenum
in an axillary node clearence which nerve is in danger of being damage
throacodorsal nerve
what cells are involved with the absorption of B12
parietal cells
what muscles attache to the greater trochanter
POGO
Piriformis
Obturator interns
Gemelli
Obturator externus
what are the key features of adenocarcinoma of the oesophagus
Progressive dysphagia, may have previous symptoms of GORD or Barretts oesophagus.
which ribs lie posterior to the kidneys
11 ans 12
what should you give to someone with pseudo colonic obstruction where supportive methods have failed
Neostigmine
what blood products can be administered to a non ABO matched recipient?
platelets
what is acalculous cholecystitis
infection of gallbladder without stones (useally in T2DM)
What is the main component of colloid in the thyroid gland?
thyroglobulin
what would cause bleeding after deffication and a cherry red lesion at the anal verge in a young child?
juvenile polyp
what is the tumour marker for ovarian cancer
CA125
what will lead to the y descent on the waveform trace ?
emptying right atrium
what does the obturator nerve innovate?
sensation - medial aspect of the thigh
Motor - adductors of Lower limb (external obturator muscle, adductor longus, brevis and Magnus, gracilis, pectinius)
which organisms commonly cause post splenectomy sepsis
Streptococcus pneumoniae
Haemophilus influenzae
Meningococci
describe the salter Harris classification
used to describe fractures in growth plates:
1- Slipped
2 - Above
3 - Below
4- through
5- rammed
what are some of the signs and symptoms of renal adenocarcinoma
mass, loin pain, haematuria, loss of appetite, fatigue, can have haemoptisis
what do chief cells secrete
pepsinogen
what is the lymphatic drainage of the overaries
para aortic
What is the path physiology of AAA
Initially loss of elastic fibres from the media then loss of collagen fibres from the adventitia
what are the nerve routes of the long thoracic nerve
C5 C6 C7
what is grey turners sign and what Is it a sign of
this is bruising to the flanks
it is a sign of pancreatitis or retroperitoneal haemorrhage
Where is the majority of iron found in the body?
Haemaglobin
von Willebrand factor is involved in the stabilization of which of the clotting factors
VIII
Which substance can be used to achieve the most accurate measurement of the glomerular filtration rate
inulin
What is type 2 statistical error
The null hypothesis is accepted when it is false
what is an isograft?
transfer of tissue between two identical individuals
What are the features of a extradural haematoma ?
- often occurs with acceleration / deceleration forces
- causes raised intercranail pressure
some people can exhibit a lucid period
what does tamoxifen increase the risk of?
venous thromboembolisms
what is the difference between an anterior and posterior duodenal ulcer?
Anterior are more common than posterior
anterior are complicated by perforation whilst posterior bleed
what is ewings sarcoma and what are some of the common signs?
sarcoma common in children
- weight loss
- temperatures
- palpable mass
- pain
what drug can cause epididymitis?
amiodarone
what are contraindications to cell salvage
malignancy and infection
if a small round lump is found on the vas following a vasectomy what is the likely diagnosis?
Sperm granuloma
if a histology report states that there is evidence of granuloma formation and central necrosis, what is the most likely underlying cause?
TB
which clotting factors are temperature sensitive?
5 and 9
what is the lymphatic drainage of the scrotum
inguinal
What are the features of Anaplastic adenoma and who is it most common in
most common in the elderly
1. rapid growing
2. Painfull nodule
what factors does warfarin affect in the coagulation cascade?
2, 7, 9, 10 and protein C
A 68 year old man presents with iron deficiency anaemia. Which site is most likely to require a biopsy in order to identify the underlying cause?
right colon - colon cancer is a big cause of iron deficiency in the right colon is the most common site of occult blood loss
how many compartments are there in the extensor retinaculum of the hand
6
To what vessels are transplanted kidneys in the LIF connected to
external iliac vessels
define epididmo-orchitis
acute inflammation of the epididymis which often involves the testes and is caused by bacterial infection
infection spreads from the urethra or bladder. If <35 can be caused by STI
how would you treat non palpable testes in a baby?
wait until 3 months of age and if still not palpable do a laproscopy
which structure lies between the lateral and medial heads of the triceps muscle?
radial nerve
what is a littres hernia
this is a hernia continaing a meckles diverticulum
what is the most common billary condition in patients with HIV
Sclerosing cholangitis due to infections such as CMV, Cryptosporidium and Microsporidia
what does the musculocutaneous nerve supply
biceps, brachialis and coracobrachialis
what are the boarders of the inguinal canal?
Superior wall (roof): 2 Muscles:Internal oblique, transversus abdominis
Anterior wall: 2 Aponeuroses: Aponeurosis of external oblique, Aponeurosis of internal oblique
Lower wall (floor): 2 Ligaments: Inguinal Ligament, Lacunar Ligament
Posterior wall: 2Ts: Transversalis fascia, Conjoint Tendon
what is the tumour marker for pancreatic cancer?
CA19-9
which nerve is often damaged in stripping of the long saphenous vein?
saphenous nerve
what muscles cause pronation of the hand
pronator teres, pronator quadratus, and brachioradialis muscles
at what level is the left main bronchus found
T6
what triad of symptoms do you get in leriche syndrome
- buttock claudication
- atrophy of the muscles in the legs.
- impotence
what hormone increases appetite
Ghrelin
what are you at risk of developing with hepatitis c
cirrhosis and therefore hepatocellular carcinoma (lesion >2cm is highly suggestive of cancer)
which hormones are decreased in stress response
insulin
tesosterone
oestrogen
what is Trousseau’s sign and what is it associated with
migratory superficial thrombophlebitis associated with adenocarcinoma of the pancreas
A 21 year old man is admitted with a tender mass in the right groin, fevers and sweats. He is on multiple medical therapy for HIV infection. On examination, he has a swelling in his right groin, hip extension exacerbates the pain. What is the most likely cause?
psoas abscess
What are the 3 branches of the facial nerve?
greater petrosal nerve
nerve to stapedius
chordates tympani
Which of the following tumour markers is used clinically to screen for recurrence of medullary thyroid cancer
calcitonin
what condition can be treated with BCG therapy?
TCC of the bladder
what is the surgical treatment of barrets oesophagus
EMR - endoscopic mucosal resection
taste loss post mastoid surgery is caused by damage to what nerve?
The chorda tympani§
at what level does the dural sac end
S2
A 1 month old baby girl presents with bile stained vomiting. She had an exomphalos and a congenital diaphragmatic hernia. What is the most likely underlying explanation?
intestinal malrotation
What is the commonest malignant tumour of the anal canal?
SCC
what are some of the tumours markers of a seminoma
AFP normal
HCG elected in 10%
- lactate dehydrogenase raised in 10-20%
What is the gold standard for the detection of renal scarring
DSMA scan
What structures are found in the adductor canal
femoral artery
femoral vein
nerve to vastas
saphenous nerve
what does the sciatic nerve innovate?
sensory: sensation to the skin of the lower leg and foot (apart from inner side)
Motor: via the tibial nerve it supplies the muscles of the posterior compartments of the lower leg. Via the common perineal nerve it supples muscles of the anterior and lateral compartments of the lower leg.
NOTHING IN THE THIGH
What is Boas Sign and what is it a sign of
hyperaesthesia felt by the patient to light touch in the right lower scapular region
sign of cholecystitis
in DIC what would you expect in the blood results
Consuptive coagulopathy
- Low platelets
- High fibrin breakdown products
Treated with supportive measures
how would you treat an ileo - colic intussusception?
pneumatic reduction with air insufflation
what is the correct management plan for a patient with acutee cholecycsistis
lap chole within 72 hours
what is released to initiate the extrinsic pathway?
Tissue factor by damaged tissues
What is Medullary carcinoma associated with
Associated with MEN 2A syndrome
what is the tumour marker for colorectal cancer
CEA
at what level is the IVC formed
L5
what does a vairus stress test measure
the strength of the lateral collateral ligament
describe the Gardner classification
used to describe intracapsular NOF fractures
1. incomplete
2. complete but no disruption to trabecular lines
3. Complete and displaced
what type of cancer is most common in people who have achalasia?
SCC
if a patient has a left sided SVC, how does the blood return to the heart?
0.3% of patients have a persistent SVC
Blood returns to the heart via the coronary sinus
what would be the cause of billious vommiting a few hours after birth?
duodenal atresia
What is the commonest type of fistula in ano?
intersphinteric
What would be the cause of bilateral facial nerve palsy, lethargy and bilateral parotid swelling
Sarcoidosis
what is the most common subtype of bladder cancer and what are common risk factors
Transitional cell carcinoma
risk factors: Smoking
other than in appendicitis when would you get a positive rovsigns sign?
in any advanced right iliac fossa pathology apart from retroceaecal appendicitis
what is the half-life of PTH
10 mins
what are some of the key features of mesenteric adenitis?
high temperature (higher than appendicitis) r
preceding viral illness
abdo pain particularly RIF
how would you treat a nephroblastoma
nephrectomy
describe some of the features of a carotid body tumour
They typically present as an asymptomatic neck mass in the anterior triangle of the neck. They are typically slow growing lesions.
Which investigation is best for initial assessment of recurrence of follicular carcinoma of the thyroid
Serum thyroglobulin
what clinical condition is caused by damage to the long thoracic nerve
winging of the scapular
What nerve innovates the gluteus medius and minimus
superior gluteal nerve
what does the nerve to obturator internus innervate ?
obturator internus and gemellus superior
What is the most important urinary acid base buffer?
phosphate
which nerves are responsible for the innervation of the FDP?
Median half (ring and little finger) - ulnar
lateral half (middle and index) - anterior interossius nerve
what is the tumour marker for liver cancer
AFP
undescended tests carries an increased risk of what condition?
testicular teratoma
what is the most common cause of painless massive GI bleeding requiring a transfusion in children between the ages of 1 and 2 years.
Meckles Diverticulum
how should DALM lesions in UC be treated
panproctocolectomy
what is Takyasu’s arteritis and what are some of the symptoms?
Inflammatory, obliterative arteritis affecting aorta and branches
Females> Males
Symptoms may include upper limb claudication
Clinical findings include diminished or absent pulses
ESR often affected during the acute phase
Which ligament contains the artery supplying the head of femur in children?
ligamentum teres
what is the preoperative / anaesthetic concern with a patient who has aortic stenosis?
Patients with aortic stenosis are a major perioperative concern. They may have ventricular hypertrophy and this can result in relative myocardial ischaemia and increase the risk of arrhymias. However, the main concern is that they cannot increase their cardiac output particularly if vasodilation occurs.
where is water reabsorption the highest
the jejunum
Which structures pass through both the lesser and greater sciatic foramen
Pudendal nerve
Internal pudendal artery
Nerve to obturator internus
What is Meckles Diverticulum
this is a true diverticulum - out pouching of the small bowel commonly containing gastric or pancreatic tissue
A 19 year old sportswoman presents with knee pain which is worse on walking down the stairs and when sitting still. On examination, there is wasting of the quadriceps and pseudolocking of the knee. What is the diagnosis?
chondromalacia patella
what cells need to be present in order for a diagnosis of barats oesophagus to be made
goblet cells + oesophageal glands
how can perthes be diagnosed?
On MRI
what is the nervous innervation of the serratus anterior
long thoracic nerve
what protein is affected in marfans syndrome
fibrillin
if a patient has otalgia post tonsillectomy which nerve is most likely responsible
glosopharengeal nerve
what is the treatment of perthes disease?
if less than 6 years: observe
if older: surgical management
what drug is commonly given in subarachnoid haemorrhages to reduce risk of raised intracranial pressure?
nimodipine
What structures are found in the anterior triangle of the neck?
Muscles:
- sternohyoid
- sternothyroid
- thyrohyoid
- omohyoid muscles
Nerves:
- vagus nerve
- hypoglossal nerve
Vessels:
- facial vessels
- Internal jugular vein
- ansa cervicalis
- common carotid
Glands:
- submandibular glands
how is intestinal malrotation treated in neonates
Ladds procedure
Which of the polyp types has the greatest risk of malignant transformation?
Villous adenomas
what are the ECG features of hypokalaemia
U have no Pot and no T, but a long PR and a long QT
flattened T wave
long PR
Long QT
U waves
if lobular carcinoma in situ is suspected what imaging should be performed
MRI
What is rovsigns sign
this is where palpation in the LLQ produces pain in the RLQ.
It is a sign of appendicitis
at what levels is the oesophagus compressed
A- Arch of the Aorta
B- Left main Bronchus
C- Cricoid Cartilage
D- Diaphragmatic Hiatus
what crystals are present in pseudo-gout and what can be used as a sign
calcium pyrophosphate crystals
transferrin levels are a sign
what cells are GIST cells derived from
inestinal pacemaker cells of cajal
how does sodium thiopentone affect cardiac contractility
causes myocardial depression
What branch of the brachial plexus is injured in a crutch palsy
Radial nerve
There are two main operations that are termed Lords procedure
one is for fissure in ano and the other is a procedure for hydrocele.
If someone has bilateral acoustic neuromas what genetic condition are they likely to have
Neurofibromatosis type.2
What is the lymphatic drainage of the ureters
Left ureter = para-aortic
Right ureter = right paracaval, interaortacaval
Which nerve supplies the dorsal aspect of the hand
The radial nerve
what cell type is likely to be high in CSF from LP of a patient with bacterial meningitis
neutrophils
what are the common symptoms of duodenal ulcer
post prandial epigastric pain
Posterior duodenal - can erode in to the gastro duodenal artery and cause beelding (melaena)
what vessel is is close proximity to the brachial plexus trunks
sub clavian artery
Which blood product is iatrogenic septicaemia most likely and why
Platelets because they are stored at room temperature
in a young man with knee swelling and no preceding trauma what would be the most likely cause
haemophilia a
what is a patent urachus
a communication between the bladder and umbilicus used to drain the fatal bladder.
what is boas sign
Boas’ sign refers to hyperaesthesia of the tip of the right scapula and is seen classically in association with acute cholecystitis
what is the ptimal operative procedure for testicular cancer? and why?
orchadectomy via inguinal approach due to Testicular tumours metastasising to Para aortic nodes
what cellular subtype are popcorn cells associated with
nodular lymphocyte predominant hodgkin lymphona
how would you treat a patient who has metastatic prostate cancer with spinal metastasis?
androgen suppressors, bisphosphinates and radiotherapy
which cerebral arteries are supplied bu the internal carotid artery
Only = Opthalmic
Press = Posterior communicating
Carotid = Choroidal
Arteries = Anterior cerebral
Momentarily = Middle cerebral
What is pembertons signs
used to evaluate venous obstruction in patients with goiters
what is buergers disease?
- occlusions of small and medium size vessels in the lower limbs
- common in young male smokers
- proximal pulses usually present but pedal pulses absent
- corkscrew shaped collateral vessels are often seen on angiography
To which vessels are transplanted kidneys anastomosed to
external iliac
Where do the majority of pancreatic cancers occur?
Head of the pancreas (70%)
what is the management of rectal varices
IV turlepressin is first line
why do some patients with renal adenocarcinoma get haemoptasis?
renal adenocarcinomas produce cannon ball lesions in the lungs which causes haemoptisis
where are inguinal hernias most likely to reoccur post repair
medial aspect near pubic tubercle
what is the most common type of renal cancer
renal adenocarcinoma
what are the borders of the femoral canal
Borders of the femoral canal
Laterally - Femoral vein (fem-or-aL Lateral)
Medially - Lacunar ligament (Lacuna matata)
Anteriorly - inguinal ligament
Posteriorl - Pectineal ligament (Posterior Pecineal)
the distal limit of the adductor canal is found in which muscle
the adductor Magnus
what is the main risk factor of the development of anal cancer
HPV virus
In Froment’s test which muscle function is tested?
adductor policus
Explain what ABPI results imply
<0.5 = severe arterial disease
0.5-0.8 = arterial or mixed arterial and venous
0.8 - 1.3 = Venus disease
>1.3 = calcification
What is the triad of wernikes encephalopathy
Triad of Wernicke encephalopathy:
Acute confusion
Ataxia
Ophthalmoplegia
what muscles does the medial nerve innovate in the hand
LOAF
Lateral 2 lumbricals
Opponens pollicis
Abductor pollicis brevis
Flexor pollicis brevis
what would damage to the recurrent laryngeal nerve cause
hoarseness or loss of voice
(innervates the intrinsic muscles of the larynx I.e. vocal cords)
Which analgesia should be avoided in renal transplants
Diclophenac
What would the diagnosis be in a young girl, mid way through her period getting right iliac fossa pain
Mittleschmirtz
what structures pass through the optic foramen
optic nerve
ophthalmic artery
how would you manage a large pancreatic pseudocyst
Elective cystogastrostomy (drain cyst in to stomach)
in what condition do you get Aschoff-Rokitansky sinuses
in a patient who has had recurrent attacks of cholecustitis (they are the result of hyperplasia and herniation of epithelial cells through the fibromuscular layer of the gallbladder wall.)
what is the contents of the inguinal canal:
Men: Spermatic cord and ilioinguinal nerve
Women: Round ligament of uterus and ilioinguinal nerve
A 73 year old man undergoes an excision biopsy of a lymph node that is closely applied to sternocleidomastoid. This muscle is mobilized and a nerve that is present is damaged. which nerve has been damaged and Which muscle is most likely to be affected?
spinal accessory nerve
trapezius muscle
what region does the intercostobrachial nerve supply
sensation to the axilla skin - commonly divided in axillary surgery
when would you do a laprascopic hernia repair?
for bilateral or recurrent cases
at what level do you find the hilum of the left kidney
L1
define and state normal value for physiological dead space with regards to ventilation
Physiological dead space: normal 150 mls, increases in ventilation/perfusion mismatch e.g. PE, COPD, hypotension
Volume of gas in the alveoli and anatomical dead space not involved in gaseous exchange.
what is goodsalls rule of fistulas
Anterior fistulae will tend to have an internal opening opposite the external opening.
Posterior fistulae will tend to have a curved track that passes towards the midline.
rom which amino acids are catecholamines primarily derived?
Tyrosine
what is the most common cancer of the renal pelvis
TCC
What would be the composition of a renal stone formed by a proteus infection
Struviate
what would be the cause of billious vomiting a few days after birth
malrotation with vulvulus
what is the treatment of colorectal liver metastasis?
chemo + surgical resection
what is Cullens sign and what is it a sign of
cullens is peri-umbilical bruising
it is a sign of pancreatitis or intra-abdominal haemorrhage
what vessel is in close proximity to the brachial plexus cords
axillary artery
which lesion is baratts oesophagus most closely associated with
adenocarcinoma
What proportion of patients presenting for cholecystectomy for treatment of biliary colic due to gallstones will have stones in the common bile duct?
10%
What is an allograft
the transfer of tissue between two individuals of the same species
what are the nerve routes of the pudendal nerve
S2,3,4
how would you investigate a TIA
arterial / carotid duplex scan
what is the lymphatic drainage of the uterus
fundus - para aortic
body - iliac
where are hassles corpuscles found
medulla of the thymus
what is an autograft?
transplant of organs or tissues from one part of the body to another in the same individual
at what level does the aorta bifurcate
L4
what type of thrombus does the contraceptive pill induce
venous thrombus
if you suspect a patient has a NOF but plain films are normal, what other investigation would you do?
MRI
what type of thyroid cancer is autoimmune thyroiditis associated with?
thyroid Lymphoma
if a patient has had a splenectomy, they are at risk of infection from what bacteria?
encapsulated bacterial e.g. haemophilis influenza, strep pneumonia and nisseria
What is rovings sign and what is it a sign of
Rovsing’s sign refers to the pain felt in the right lower abdomen upon palpation of the left side of the abdomen.
sign of appendicitis
what inveistigation would you do to investigate IBD
feral calprotectin
if you fracture your humerus which nerve do you need to be concerned about
radial nerve (spirals around the humorous in middle third)
What are the features of papillary carcinoma and who is it most common in
Most common in Young people
1. Painless
2. Slow growing
3. Multi-focal
4. lymphatic spread
where are hassles corpuscles found?
in the thymus gland
what innervates the crycothyoid
external laryngeal nerve
where is iron absorbed in the gut
duodenum
what is the blood supply to the small intestine
celiac trunk and superior mesenteric artery
which nerve can be found in both the greater and lesser sciatic foramen
pudendal nerve
What are the 3 gluteal muscles
Gluteus maximus, Gluteus medius, gluteus minius
what clotting factors does liver disease affect
Factors 1,2,5,7,9,10,11
in froments test which muscle is tested
adductor policus
what is the treatment of cystic stump leak
ERCP , sphincterotomy and stent
what is the treatment of a malrotation in a neonate with billious vomiting from malrotation
Ladds procedure
how should varies be treated?
- turlopressin
- endoscopic banding
- TIPs
what is the most common cause of filariasis
Wucheria Bancrofti
what are some of the features of Ulcerative colitis?
- occur in the rectum and colon
- contact bleeding
- superficial inflammation
- distribution is continuous
- histologically: crypt abscesses and inflammatory cells in the lamina propria
if a lung lesion is found to contain connective tissue, mature cartilage and ciliated epithelium what type of lung lesion is it\
harmatoma - most common in the lungs
If a 2 x 2 cm autologus skin graft is placed on an area of healthy granulation tissue. After about a week, a thin bluish - white margin appears around the graft and spreads at a rate of 1mm per day. What is it?
epidermis - the process is called re epithelisation
A 2 week infant has foul smelling material discharging from the umbilicus. What is the underlying problem
Distal enter-cutaneous fistula
for a gastric cancer in the greater curvature of the stomach and no metastasis, how would you treat?
subtotal gastrectomy with roux en Y
what is fillariasis and what are its common symptoms
Filariasis is an infectious tropical disease caused by any one of several thread-like parasitic round worms.
Signs and symptoms: lyphoedema , they are brawny and indurated with marked skin trophic changes
what structures attaches periosteum to bone
sharpeys fibres
what causes secretions of enzymes from the pancreas
cholocystokinase
What is the commonest malignant tumour of the anal canal?
SCC
What is a type 1 statistical error
The null hypothesis is rejected when it’s true
Which ligament keeps the head of the radius connected to the radial notch of the ulna?
annular ligament
An elderly diabetic male presents with a severe deep seated otalgia and a facial nerve palsy, he has completed a course of amoxycillin with no benefit. What is the most likely diagnosis
malignant otitis externa
Beta-naphthalamine is associated with which of the malignancies?
bladder
define millroys disease
this is a lymphedema present from birth
onset <1 year
how should bleeding duodenal ulcers be treated?
with adrenalin injections?
A thyroidectomy specimen from a 45 year old man shows a mass with prominent oxyphil cells and scanty thyroid colloid. What is the underlying cause?
Follicular Carcinoma
what are the contents of the cavernous sinus
O TOM CAT
Occulomotor nerve (III)
Trochlear nerve (IV)
Ophthalmic nerve (V1)
Maxillary nerve (V2)
Carotid artery
Abducent nerve (VI)
T
what should you give a patient with von willerbrands disease to prevent bleeding
Desmopressin
what are thebesian veins and where do they drain to
they are small vessels that are found on the surface of the heart and drain in to the atrium
Define Chondromalacia Patellae and what are they symptoms?
this is inflammation of the underside of the patella.
Symptoms include pain on activity and sitting for prolonged periods of time
often affects young athletic individuals
what structures does the facial nerve supply?
Face, Ear, Taste, Tear
Face - muscles of facial expression
Ear - Nerve to stapedius
Taste - Supples anterior 2/3 of the tongue
Tear - Parasympathetic fibres to lacrimal glands and salivary glands
Which nerve passes posterior medially to first rib
phrenic nerve
What is the treatment of an intracapsular NOF?
Displaced: Hemiarthroplasty / THR or if young and fit can have cannulated screws
Undisplaced: Cannulated screws or conservative
Which nerve supplies the medial aspect of the palm
The ulnar nerve
what is the treatment of a hydrocele
Treatment in adults is with a Lords or Jabouley procedure.
Treatment in children is with trans inguinal ligation of PPV.
what is the blood supply to the breast
internal and external mammary arteries
anterior intercostal arteries
thorco-acromial arteries
what is the physiological significance of the femoral canal
allows the femoral vein to expand for increased venous return
What are some of the features of meniscal tears?
- from rotational sports injures
- delayed knee swelling
- true locking of the knee
What is the treatment of ulcerative colitis
- Medical management: IV hydrocortisone 100mg QDS
- Subtotal collectomy
how is achondroplasia inherited
autosomal dominant
what is richters hernia
this is a hernia containing a portion of the anti mesenteric border of the bowel wall
What is the typical stroke volume in a resting 70 Kg man
70mls (typically between 55 - 100)
What is the treatment of binary atresia in young children
Roux on y
when does graft vs host disease commonly occur
4-30 days post transfusion
what are the signs and symptoms of testicular torsion
- severe pain and sudden onset
- loss of cremasteric reflex
- elevation of the testis does not relieve pain
what is the most appropirate investigation for a child with a suspected SUFE
hip X ray
