Jan 2023 Recalls Flashcards
What is the half life of platelets?
7-10 days
A bullet is shot at the right side of the rectus muscle where is meets the right costal margin, which organ is most likely affected?
Gallbladder
Where are paneth cells located?
Crypt of Lieberkuhn - small intestine
Effect of respiratory depression on ABG?
Respiratory acidosis due to hypoventilation
What acquired bleeding disorder occurs with warfarin?
Prothrombin deficiency
A female with rheumatoid arthritis and asthma is on Prednisolone 10mg BD and Salbutamol. Comes into hospital unwell with fever and vomiting. They are hypotensive. What medication do you need to consider giving?
Hydrocortisone 100mg IV
Features of aortic sclerosis
Ejection systolic murmur - no radiation to carotids
Diagnosed on ECHO - thickening and calcification of aortic valve leaflets, no motion restriction
Child is tired and breathless after playing football. Harsh continuous murmur heard under left clavicle. What is the problem?
Patent ductus arteriosus - machinery continuous murmur
Primigravida, 24 years old. Third trimester. Father died of MI at 60. Presents with sudden chest tightness, cyanotic with congested neck veins. What is the cause?
Acute massive PE
Causes right heart strain, hence the congested neck veins.
Cyanotic due to hypoxia.
Which medication would you choose to sedate a hypotensive patient for intubation if on a helicopter?
Ketamine
10 days after an anterior resection, a patient developed SOB and cough. ECG was normal. Which initial investigation should you do?
Apparently the answer was CTPA, although I would do CXR first.
?weird wording
Why will a patient have high K, low urine output and raised creatinine after abdominal aortic aneurysm surgery?
AKI
Needs fluids, stop nephrotoxic drugs
Features of testicular torsion eg sudden onset scrotal pain, testis elevated and tender, absent cremasteric reflex whilst eating. What do you do?
Immediate exploration under GA - RSI.
Do not wait 6 hours to be fasted
After abdominal aortic aneurysm repair a patient has increased ventilatory demand, a pulmonary artery wedge pressure 20, dilated neck veins and low BP. CXR shows bilateral lung opacities. What is the diagnosis?
Pulmonary oedema
Pulmonary artery wedge pressure - normal range 6-12, is also known as pulmonary artery occlusion pressure. It is an indirect way of measuring left atrial pressure and the gold standard for diagnosis of acute pulmonary oedema.
What would you expect to see on a post splenectomy blood film at 1 week?
Howell-Jolly bodies
Target cells
Pappenheimer bodies
Acanthocytes
RBC pitting
Thrombocytosis
Transiently raised WCC- if still raised after 5 days then think of infection
Pretibial flap injury 6x2cm. Periosteum is intact but edges cannot be approximated. What is the management?
Definitely Split thickness skin graft
I think the lacerated flap needs excising first
What is seen on histology for amyloidosis?
When stained with congo red, it appears apple green birefringence in polarized light
What is the choice of anaesthetic drug for a biers block?
Prilocaine 0.5%
An amide local anaesthetic
Slightly less cardiotoxic than bupivicaine and lidocaine
Mother of 3 children, came with pruritus ani, scotch tape showed eggs. What is causative organism?
Enterobius vermicularis
Patient presenting with bloody diarrhoea. Stool shows both eggs and cysts. Given the diagnosis, what is the treatment?
It is either giardia or cryptosporidium
Both are treated with metronidazole.
Knee injured during football match, can’t continue playing. Immobilised for one week. After one week, tender swelling
2.5cm above knee medial joint line and excessive lateral angulation of knee compared to the other one. Which ligament is damaged?
Medial collateral ligament
Lateral angulation = Valgus deformity
A patient has had a thumb cast on for 4 weeks for an undisplaced fracture. When cast is removed the patient is unable to lift thumb off the table and patient can’t extend IPJ even after stabilising thumb CM joint. What is damaged?
Extensor pollicis longus tendon
Which part of the scaphoid is at risk of avascular necrosis?
Proximal pole
Preiser’s Disease
Scaphoid blood supply is dorsal carpal branch of the radial artery via retrograde flow
Which spaces are usually involved with Ludwig’s angina?
Submandibular, sublingual and submental.
Ludwigs angina is cellulitis of he floor of the mouth.
It presents with pain on moving tongue, difficulty swallowing saliva, pain on opening mouth.
Often requires surgical drainage
Patient is experiencing pain 10 years post mid tarsal dislocation. What is the cause?
Secondary arthritis
Patient involved in car crash, hits back of driver’s seat, leg is
shortened and internally rotated, all motor function of leg lost. What is the injury?
Posterior hip dislocation
Common injury in car crash
Presents with internally rotated, shortened and adducted leg
After gastric bariatric surgery, patient has been getting symptoms of sweating, palpitations, convulsions. What would be
the cause?
Dumping syndrome
?Vagotomised early gastric relaxation
What is the histological appearance of osteoporosis?
Reduction in the amount of osteoid matrix (decreased volume), but normal mineralisation of it
A patient has fallen onto their chin, reduced mouth opening, jaws are not aligned like they used to and they are unable to bite. There is pre auricular tenderness. Which part of
mandible fracture?
Mandibular condylar fracture
Patient 6 months post tooth extractionis now presenting with pus, multiple sinuses and yellow granules.
Actinomycosis
Teeth extracted, pt develops numbness of gum, chin and lower lip. Which nerve traversing through the body of mandible
is responsible?
Mental nerve - terminalbranch of the inferior alveolar nerve
Traverses through mandibular canal in mandible.
Patient underwent Colonoscopy under conscious sedation. On the ward, the patient is unresponsive and the nurse informs you that the respiratory rate is slow. You examine the patient and he is sleeping. Despite the dark room, his pupils are constricted. What reversal agent is required?
Naloxone
Unilateral Buttock claudication, causative vessel
common iliac artery
A gardener gets a thorn stuck in their arm. A photo is provided showing surrounding cellulitis and lymphangitis 2 days later. What is the causative organism?
Sporothrix schenckii
Which is the cause of vasoconstriction on efferent arterioles?
Angiotensin 2
Senescence of cancer cells
Telomerase
Superior thyroid artery ligated, now can’t produce high pitched voice, injury to?
Cricothyroid muscle
What cells produce complement factors?
Hepatocytes
What is the lymph node drainage of the glans of the penis
deep inguinal lymph nodes
What is the histology of giant cell arteritis?
chronic granulomatous macrophages
lymphocytes inflammation
What clinical examination test is used to determine achilles tender rupture?
Simmonds Thompson test - squeeze calf
What nerve root is damaged if there are features of horners syndrome and numbness on the medial side of elbow?
T1
Patient with diabetes presenting with oliguria, hematuria.
There is slough in urine. Diagnosis?
Acute tubular necrosis
80 year old lady who smoked for 20 years, smooth, red and velvety patch on her tongue. What are the patches called?
Erythroplakia
Temporal bone fracture after high velocity accident, patient has otorrhea. Damage to which structure causes CSF to leak externally via ear?
Tegmen Tympani
Also known as the tegmental wall or roof of the tympanic cavity, is a thin plate of the petrous part of the temporal bone that separates the intracranial compartment and middle ear.
20y/o man, Urethral rupture, blood at urethral meatus and
high riding prostate What part of urethra injured:
Membranous urethra
Which syndrome involves both endometrial and colorectal cancer?
Lynch syndrome
3% burn in forearm with crusting, dry and loss of sensation,
management post debridement?
Split thickness skin graft
Acutely swollen and painful knee. No hemarthrosis,
Apyrexial and WCC normal. Definitive diagnosis by?
Arthroscopy
Which enzyme is responsible for autolysis in pancreatitis?
Trypsin
What is the formula for NNT
1/ARR
Admitted with acute pancreatitis..patient managed..repeat
CT imaging after 4 days shows diffuse fluid around the head
body/tail of pancreas are non-enhancing ?cause
Pancreatic necrosis
Where are the central chemoreceptors located?
Medulla
Where does furosemide act in the kidney?
Ascending loop of henle
What structure is at risk when preparing tibia with saw for knee replacement surgery?
Popliteal artery
6 months old boy with 24 hrs history of abdomen
distension, pyrexial, screaming, vomiting bile stained, small
amount of blood and mucus on PR
Intussusception
Where does ADH act in the kidney?
Distal convoluted tubule and collecting duct
Traumatic aorta injury present to emergency with widened
mediastinum, where is most likely
Descending aorta
What bacteria will not be killed if autoclave is on 100 degrees celsius
clostridium difficile
What is the nerve supply of the labia majora
ilioinguinal nerve L1
78 year old male traumatic head injury patient, long time
taking to recover, need long term nutritional support ?
PEG
Structure at greatest risk during splenectomy
Pancreas tail
Lung function tests showing restrictive pattern. What is the cause?
Pulmonary fibrosis
Non differentiated thyroid cancer. What screen test for recurrence?
Thyroglobulin
Where is the brachial artery in relation to the biceps tendon?
Medial
In the ACF (lateral to medial) is:
- Radial nerve
- Biceps tendon
- Brachial artery
- Median nerve
Elderly man, has referred back pain to legs, improves on
pushing trolley n climbing uphill. While increases with going
down hill.. cause?
Lumbar canal stenosis
Residual 250 cm ileum after distal ileocolic resection. What
nutritional support is necessary?
Oral supplementation
What type of joint is the carpometacarpal joint of thumb?
Saddle
Management of aortic aneurysm between 4.5 and 5.5cm?
3 monthly USS
What is seen on the histology for medullary thyroid cancer?
Stroma with amyloid deposits. Round, plasmacytoid, polygonal or spindle cells in nests
Round nuclei with finely stippled to coarsely clumped chromatin
What nerves arise at the cerebellopontine angle?
Trigeminal- more pons really
Facial
Vestibulocochlear
According to embryology, why does cleft lip occur?
Occurs when the medial nasal prominence and maxillary prominence fail to fuse.
How does diarrhoea lead to metabolic acidosis?
Loss of bicarbonate
What nerve innervates the temporalis muscle?
Mandibular CNV3
What nerve provides scalp sensation behind ear?
Lesser occipital nerve
70 years old woman with extensive ovarian cancer, 5.5
cm aneurysm of external iliac artery. Management:
Surveillance in 3 months
Patient with anaemia and autoimmune thyroiditis with
atrophic gastritis, endoscopy normal. Size of RBC?
Large oval
Megaloblastic macrocytic anaemia (pernicious anaemia)
smoker, unilateral laryngeal swelling, nodule on vocal cord,
no LN involvement. What type of cancer?
SCC
What is little’s area?
AKA Kiesselbach’s plexus.
It is the anastamosis of 5 arteries:
- anterior ethmoidal
- posterior ethmoidal
- Sphenopalatine
- Greater palatine
- Septal branch of the - Superior labial artery
What is the least reliable sign for examination of compartment syndrome?
Absent pulse - late sign
Cause of sudden onset L forearm pain and superiorly displaced
mitral valve leaflets during systole on echo
Brachial artery embolism
Subclavian steal syndrome, retrograde flow in which vessel?
Vertebral
Laceration 3cm from wrist joint, reduced wrist flexion, ulnar
deviation. Which nerve is injured?
Median
Severe renal disease with foot ischemia. Which investigation is most appropriate?
US duplex
45 female with discrete breast nodules showing dense fibrous
tissue with no microcalcification, Diagnosis?
Fibrocystic
What is cushing’s triad?
Widened pulse pressure
Bradycardia
Irregular respirations
Known breast carcinoma, now presenting with headache and vomiting?
Think increased SOL
Dexamethasone
What do keratin pearls indicated?
Oesophageal SCC
What is raised in yolk sac variant of testicular tumour?
AFP
What is buck’s fascia?
Deep layer of penile fascia that covers both corpus carvernosa and corpus spongiosum
What is the landmark for a pudendal block?
Ischial spine
Which muscle relaxant is depolarising?
Suxamethonium
8mm ureteric stone at ureterovesical junction. Pyrexial 38.9
with dilation
Cystoscope and JJ stent
What electrolyte disturbance causes perioral tingling?
Hypocalcaemia
Patient with recently diagnosed pancreatitis who suffered
from seizures. Muscle weakness, hyper reflexia . ECG shows
prolonged QT?? and T-wave inversion, which electrolyte?
Hypocalcaemia
Teardrop sign in the maxillary sinus, what is the cause?
Orbital floor fracture
Thyroglossal cyst investigation?
USS and FNAC
Define amelia
complete absence of the skeletal parts of a limb
Bone mets after breast cancer ,management of pain?
NSAIDs
Where does the lower part of the anal canal drain its lymphatics to?
superficial inguinal lymph nodes
Le fort level 3 fractures require which type of airway management?
tracheostomy
Lesion in what structure causes a homonymous hermianopia?
Optic tract
Level 5 lymph node dissection of neck. What nerve is at risk of damage?
Spinal accessory nerve
What condition are Necrobiosis granulomas associated with ?
Rheumatoid arthritis
Where does the vagus nerve enter the abdominal cavity?
Oesophageal hiatus
What type of cancer is myasthaenia gravis associated with?
Thymoma
What blood test can help diagnose allergies?
Tryptase - comes from mast cells
Where are IgA antibodies produced?
Mucus membranes of digestive tract
What is a sestamibi scan used for?
to evaluate function of parathyroid glands
What nerve supplies the skin on the dorsum of the foot?
Superficial peroneal nerve
What nerve root supplies pelvic diaphragm?
S3
What type of cancer is caused from schistosomiasis haematobium?
Bladder SCC
What type of hernia occurs when the pleuroperitoneal canal persists?
Bochdalek hernia
Why does hypospadias occur?
Urogenital fold on ventral penis
What ECG change is seen due to hypothermia?
J wave
Where are the nuclei for CN 9 and 10 located?
Medulla oblongata
Where would bleeding post lumbar puncture come from ?
Vertebral venous plexus
Asthmatic on 15mg prednisolone for emergency repair of
tibia, how to increase dose?
Double dose on day of surgery and next 2-3 days
lady with bilateral inguinal node..likely from
labia minora/clitoris
From ejaculatory duct sperm transmit to which part?
prostatic urethra
chorda tympani skull exit ?
Petrotympanic fissure
How smoking lead to ischemic foot ?
oxygen radicals effect nicotinic receptors
lymphatic drainage of the caecum
ileocolic
What types of polyps are seen in FAP
tubular adenoma
Neck mass with compressive symptoms?
retrosternal goitre
Supply to which structure defines left heart dominance?
circumflex artery
Cause of varicocele, blockage in which vessel?
testicular vein
Need to do abdominal USS to exclude tumour compressing vein
What maintains the resting potential?
K
Stricture in biliary ducts is associated with which disease?
Ulcerative colitis
How does prostate ca metastasise to spine?
Vertebral venous plexus
What is the idication for a ventilatory support in a burn patient?
carboxyhemoglobin 20%
Type of gallbladder stone in sickle cell patient ?
pigment and cholesterol
Which structure crosses external iliac vessel to enter deep inguinal ring?
Inferior epigastric vessels
Factors responsible for coagulopathy and hyprfibrinolysis in poly trauma
Activated protein c and plasminogen
When a tourniquet is released, what causes vasodilation in systemic arterioles?
Histamine
16 yr old with soft tissue mass?
ewings sarcoma
Which nerves are responsible for maintaining an erection
I think pudendal although the answer on this recall was parasympathetic pelvic splanchnic nerves
What is the action of the psoas muscle?
Flexion and abduction
Which nerve root supplies extensor hallicus longus?
L5
What is the lymphatic drainage of the body of the uterus?
external iliac lymph nodes
Which type of shock causes a low SVR?
Septic
What nerve provides taste sensation to the anterior 2/3 of the tongue?
Facial nerve via the chorda tympani
Where does the facial nerve exit the skull?
Stylomastoid foramen
It leaves the cranial cavity via the internal acoustic meatus, then travels through the facial canal to exit the skull via the stylomastoid foramen.
Histology of a discrete palpable lump in the breast of a 34-
year-old woman has shown Apocrine metaplasia, epithelial
overgrowth and papillary projections. What is the most Likely
pathological process ?
Benign breast cyst
