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MRCS Part B > Misc 9 > Flashcards

Misc 9 Flashcards

1
Q

What are isolated juvenile polyps usually?

A

Hamartomas with no risk malignancy

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2
Q

Lynch syndrome carries risk of which cancers?

A

Colorectal Ca

Endometrial Ca

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3
Q

What is the nerve supply to the oesophagus?

A

Upper half = recurrent laryngeal nerve

Lower half = oesohpageal plexus (vagus)

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4
Q

Describe the segmental blood supply to the oesophagus?

A

Upper third = inf thyroid veins and artery
Middle third = direct from thoracic aorta, azygos veins
Lower third = left gastric artery and veins branches

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5
Q

Finding which cells on path examination of the thyroid would suggest inadvertant removal of parathyroid?

A

Oxypihl cells

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6
Q

Most common benign liver lesion?

A

Haemangioma

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7
Q

Main RF for hepatic adenomas?

A

OCP/high hormonal potency agents

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8
Q

1 word summaries of 4 types of hypersensitivity reactions?

A

1 - allergic/anaphylactic
2 - cytotoxic
3 - immune complex
4 - delayed t cell

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9
Q

1 word summaries of 4 stages of wound healing?

A

1 - haemostasis
2 - inflammation
3 - regeneration
4 - remodelling

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10
Q

Give 3 main causes of chronic inflammation?

A

Chronic, persistent infection with delalyed hypersensitivty type
Prolonged exposure to nonbiodegradable surfaces e.g. silicon or suture material
Autoimmune condiions

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11
Q

Most common primary immunodef?

A

IgA deficiency

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12
Q

Describe roughly how to do open AAA repair?

A 
Laparotomy
Mobilise bowel and duodenum out way
Mobilise aneurysm  neck and base
Start systemic heparinization
Cross clamp proximally then distally
Longitudinal aortotomy
Atherectomy
Graft repair - straight or bifurcating
Suture in
Clamps off
Haemostase
Close aneurysm sac
Close abdo wall and skin
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13
Q

When is the highest risk of cardiac event during AAA repair?

A

When clamps removed - reperfusion

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14
Q

What BP would you aim in ruptured AAA?

A

80-100 systolic - permissive hypotension

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15
Q

Which 3 forearm tendons dont participate in the flexor retianculum?

A

Flexor carpi radialis and ulnaris

Palmaris lonogus

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16
Q

Injury to whic area of the hand carries highest risk of migration of infection? Why?

A

Palmar surface of little finger - flexor sheath of little finger is continuous with common flexor sheath which extends proximally under flexor retianculum

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17
Q

Criteria for diagnosing IBS?

A

Rome criteria

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18
Q

Operation for inguinal hernia repair in kids vs adults? Why?

A

In kids - herniotomy, usually indirect

In adults - herniorraphy

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19
Q

Procedure of choice for a pleomorphic adenoma?

A

Superficical parotidectomy with facial nerve presrvation

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20
Q

What is the most common unilateral vs bilateral benign parotid tumour?

A 
Unilateral = pleomorphic adenoma
Bilateral = Warthins tumour
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21
Q

Which parotid tumour is more common in men than women?

A

Warthins tumour

22
Q

Most common malignant parotid tumour? Second most?

A

Mucoepidermoid carcinoma

Adenoid cystic carcinoma

23
Q

Procedure of choice for malignant parotid tumours?

A

Radical/excisional parotidectomy

24
Q

What about prolene makes it sutitable for vascular anastomoses?

A

Monofilmaent with memory that doesnt incite tissue reaction and is non-absorbable

25
Q

Why is PDS useful in abdo wall closure?

A

Strong monofilament, synthetic so minimal tissue reaction. Absorbed over long period of time

26
Q

Why is lidocaine less useful for e.g. lap port sites for post op analgesia? What is preferred?

A

Short acting

Better is bupivocaine or chirocaine

27
Q

Which LA cant be used in regional blocks? Why?

A

Bupivocaine - cardiotoxic, in case tourniquet fails

28
Q

What is agent of chocie for e.g. Biers block?

A

Prilocaine

29
Q

What is the role of arterial thrombolysis in acute limb ischaeima?

A

Better for acute on chronic thrombosis, and beter than peripheral thrombolysis, but avoid if recent surgery or stroke. Consider with/wihtout clot aspiration

30
Q

Where may T tube drains be useful? Why?

A

E.g. in bile duct - to generate fibrosis along drain tract so less risk of leak on removal

31
Q

What are cleaning, sterilisation and disinfection?

A 
Cleaning = removal of all visible foreign bodies, must be done first
Disinfection = reduction in number of microorganisms
Sterilisation = eradication of all microorganisms
32
Q

Nosocomial surgical site infections occur within how long of surgery?

A

30 days; 1 year if prosthesis used

33
Q

What is the LN drainage of the anorectum?

A

Rectum above dentate line = mesorectal LNs

Anal canal below dentate line = inguinal canal

34
Q

Which fascia are related to the rectum and removed in mesorectal excision?

A

Denonvilliers anteriorly

Waldeyers fascia posteriorly

35
Q

Aterial supply to trachea?

A 
Superior = inferior thyroid artery
Inferior = bronchial artery
36
Q

Surface marking for the sciatic nerve in the buttock?

A

Midway between greater troch and ischial tuberosity

37
Q

What is the NHS UK bowel screening programme?

A

Over 55s invited for 1 off flexi sig

60-74 = FIT testing every 2 years

38
Q

How would you investigate and manage ?SCC of tonsil?

A

EUA and tonsillectomy for histology

If confirmed - MRI, CT CAP and discuss at MDT

39
Q

What are the levels of LNs in the neck?

A

1 - submental/submandibular
2 - upper 1/3 IJV - from skull base to hyoid
3 - middle 1/3 IJV - from hyoid to cricoid
4 - lower 1/3 IJV - from cricoid to clavicle
5 - posterior triangle
6 - from hyoid to suprasternal notch
7 - superior mediastinal

40
Q

What are the 3 types of neck LN dissection?

A

Radical/en bloc - all removed, SCM, IJV, CN11
Modified radical - all removed but SCM/IJV/CN11 preserved
Selective - Removal of certain LN chains and preservation of SCM IJV CN11

41
Q

Who might an oncology MDT involve?

A 
Surgeons
Oncologists
Radiologists
Pathologists
SNs
Depending on location e.g. dietician/SALT for head and neck, stoma nurses/dieticians GI, plastics/derm for skin
42
Q

Indications for TURP for BPH?

A

Severe BPH sx refractory to medical management
Unusually large or shaped prostate
Renal failure/recurrent UTI secondary to obstruction
Recurrent gross haematuria
Large bladder diverticular

43
Q

What should patients with Gleason over 7 or PSA over 10 undergo?

A

Staging scans

44
Q

What investigation might patients with a bile leak need?

A

ERCP to look for leak site - extravasation of contrast into abdomen

45
Q

How are post op bile leaks managed?

A

IV fluids and antibiotics
Refer to tertiary HPB centre for either stenting or reconstruction (bilienteric anastomosis) e.g. Roux en Y choledochoduodenostomy

46
Q

What is the Dukes classification for? Describe it

A 
CRC
1 - mucosa only
2 - through musclar layer
3 - LNs
4 - distant mets
47
Q

What imaging is best for cancers of the urinary tract depending on suspciion of location?

A

Kidneys - CT renal
Ureter/bladder - CT urogram
Prostate - MRI

48
Q

What ABPI would be consistent with critical limb ischaemia?

A

Less than 0.5

49
Q

What is a pharyngeal pouch also called and where does it arise?

A

Zenkers diverticulum - just above cricopharyngeus, below inferior constrictor, through killian’s dehiscence

50
Q

Surface marking for SFJ?

A

4cm inferior and lateral to pubic tubercle

51
Q

Relatnioship between femoral triangle and subsartorial canal?

A

Boundaries of fem triangle are sartorius and aductor longus

Vessels/nerve descend below sartorius, new boundaries are adductor longus and vastus medialis

52
Q

What is at the end of the subsartorial canal?

A

Hiatus in adductor magnus

MRCS Part B (25 decks)

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