Misc eMRCS Flashcards
Blood film findings post splenectomoy
Howell Jolly Body
Pappenheimer bodies
Target cells
Erythrocyte containing siderotic granules
Where do giant cells come from
macrophages
Bloods tests for carcinoid tumour
lbood tests usually measure chromogranin A
,neuron-specific enolase (NSE), substance P
and gastrin
Findings in follicular carcinoma
prominent oxyphil cells and scanty thyroid colloid
What is the initial location of the metanephric cap from which the kidney is derived?
Medial to ureteric bud in the pelvis, failure to migrate leads to pelvic kidney
What incision is made for laparotomy in young children?
Transverse supra umbilical
Aberrant Gantzer muscle
The Gantzer muscle is an aberrant accessory of the flexor pollicis longus and is a risk factor for anterior interosseous nerve compression
Where is mesh placed in an open inguinal hernia repair?
posterior to cord structures
Where are majority of AAA located?
inferior to renal artery
Which arteries experience reversal of blood flow when axillary artery is ligated?
flow is reversed in the circumflex scapular and subscapular arteries forming a collateral circulation around the scapula
What structure is commonly divided in median sternotomy?
The interclavicular ligament lies at the upper end of a median sternotomy and is routinely divided to provide access
Causes of increased anion acidosis
M - Methanol
U - Uraemia
D - DKA/AKA
P - Paraldehyde/phenformin
I - Iron/INH
L - Lactic acidosis
E - Ethylene glycol
S - Salicylates
What structure is most at risk during saphenofemoral junction ligation?
The deep external pudendal artery runs under the long saphenous vein close to its origin and may be injured
What pressure is the insufflation machine set to during laparoscopy?
10mHg
Management of DALM in UC
Panproctocolectomy
Common cause of pruritus ani
Enterobius vermicularis
Adductor canal compression syndrome
Adductor canal compression syndrome most commonly presents in young males and is an important differential diagnosis in men presenting with symptoms of acute limb ischaemia on exertion. It is caused by compression of the femoral artery by the musculotendinous band from adductor magnus muscle
What type of hypersensitivity is granuloma formation
Type 4
Where are oxyphil cells normally found?
Parathyroid
Normal gap acidosis
H - Hyperalimentation/hyperventilation
A - Acetazolamide
R - Renal tubular acidosis
D - Diarrhoea
U - Ureteral diversion
P - Pancreatic fistula/parenteral saline
Popcorn cells in Hodgkin lymphoma
nodular lymphocyte predominant Hodgkin lymphoma
Necrosis on CT Brain, tumour type
Significant necrosis is more commonly seen with glioblastomas than with other CNS tumours.
What artery supplies lacrimal gland?
Ophthalmic
Reservoir of campylobacter
Birds
What is spleen derived from
mesenchymal tissue
What structure is commonly affected in disc prolapse of spine
In disk prolapse the nucleus pulposus is the structure which usually herniates
What is affected in Marfan’s
Fibrillin
Urine specific gravity in hypovolaemic shock
increased
Most common adverse event following FFP
Urticaria
Which splenic structure lies most posteriorly?
Lienorenal ligament
Melanosis coli
This may occur as a result of laxative abuse and consists of lipofuschin laden macrophages that appear brown
What is the defect in Lynch syndrome
Mismatch of DNA repair genes
Where do lesions distal to dentate line metastasise to
inguinal
Most common abdominal emergency in children < 1
intusussception
What is contraindicated in ventricular tachycardia
verapamil
Brittle bones, lack of differentiation between medulla and cortex
Osteopetrosis
Analgesia in term neonates
Codeine and ibuprofen are contraindicated
Treatment for metastatic bone compression in prostate cancer
Androgen suppression
Bisphosphonates
radiotherapy
Indications for ER Thoracotomy
Penetrating thoracic trauma that is then followed by cardiac arrest in the department
Causes of red urine
rifampicin
beetrot
rhubarb
blackberries
What structure can be damaged in an Ivor-Lewis Oesophagectomy
lymphatic duct leading to chyle leak
What type of laxative is senna?
stimulant
Which HLA is most important in renal transplant?
DR
What anaesthetic is used in Biers block?
1% prilocaine (the only LA to be inserted IV)
What sing is absent in retrocaecal appendicitis?
Rovsings may be absent
EBV vs CMV in post renal transplant
EBV > 6 months after transplant
how is low flow priapism treated?
aspiration of blood from corpus cavernosum
Initial treatment in thyrotoxic storm
Beta blockers and thionamides
Kocher’s septic arthritis for children
WCC >12
Inability to weight bear
Fever
ESR >40
= >90 chance of septic arthritis
Risk of redo fundoplication
Redo fundoplication surgery carries with it a risk of damaging the vagus nerves.
Post ERCP abdominal pain, DDx and Ix
One is pancreatitis, repeated trauma to the ampulla and duct (if partially cannulated) is a major risk factor for pancreatitis. The second is the possibility that the duodenum has been perforated.
CT scan
What is the outcome measured in cohort study?
Relative risk
Fluids requirement for term neonate
100ml/kg/day
Biopsy in melanoma
Avoid incisional or punch biopsy of lesions suspected to be melanoma. (excision biopsy is best)
What to not give in compartment syndrome
anticoagulation
Contraindications to lung cancer surgery
include SVC obstruction, FEV < 1.5, MALIGNANT pleural effusion, and vocal cord paralysis
Which muscle can be retracted to improve access to femoral artery distally?
sartorius
Features of enteroinvasive e.coli
Necrosis and ulcers of the large bowel are a feature of enteroinvasive E.coli.
From which amino acid are catecholamines mainly produced
tyrosine
structure divided in retrocaecal appendix
Those struggling to find it at operation should trace the tenia to the caecal pole where the appendix is located. If it cannot be mobilised easily then division of the lateral caecal peritoneal attachments (as for a right hemicolectomy) will allow caecal mobilisation and facilitate the procedure
musculoaponeuostic and aggressive fibromatosis
desmoid tumours
Which structures can be damaged during caecal mobilisation
gonadal vessels
What structure lies underneath the lateral aspect of biceps femoris
common peroneal nerve
Which cell is affected in osteopetrosis?
osteoclast
What is the location of the ureter
he ureter lies anterior to L2 to L5
Where are the largest proportion of musculi pectinai found?
right atrium
Ix for ?pharyngeal pouch
upper GI fluoroscopic study
Which organisms can give an achalsia like picture
Tryp Cruzi
Where are Hassall’s Corpuscles seen?
medulla of the thymus
Which synrome is associated with retinal haemorrhage?
VHL
Which process described the formation of AAA
loss of elastic fibres frmo the media
Oedema following burns
Reduction in capillary oncotic pressure
What structure is divided in midline incision
linea alba
Where are the reticuloendothelial cells concentrated within the spleen?
within the white pulp
At what level does the renal artery branch of aorta
L2
How does tranexamic acid work?
inhibits plasmin and prevents fibrin degradation
Which splenic structure lies most posteriorly?
lienorenal ligament
Where do the majority of traumatic aortic ruptures occur?
distal to left subclavian artery
Management of cystic stump leaks post cholecystectomy
ERCP and stent
What is a richter’s hernia
When part of bowel is trapped in the hernia
Prerequisite for charcot foot
trauma
Histology of pleomorphic adenoma
biphasic appearance of the lesion and mucinous connective tissue.
Describe a dermoid cyst
multiloculated and heterogeneous
Associated features of malrotation
exompahlos and diaphragmatic hernia
Commonest site of fluid collection following perforated appendix
pelvis
Sx of sialolithiasis
bad breath, dry mouth, pain when eating
Orchiedectomy in testicular malignancy
INGUINAL APPROACH
HPB condition associated with HIV
Sclerosing cholangitis
Which skin condition can resemble a malignant melanoma
spitz naevus
What must be ruled out in a painful third nerve palsy
posterior communicating aneurysm
What condition is IGF1 gene implicated in
HNPCC
Treatment of non resectable GIST, KIT positive
Imatinib
What time frame is secondary haemorrhage likely to occur post tonsillectomy
5 - 10 days
Most common cause of osteolytic bone mets in children
neuroblastoma
Which vessels are transplanted kidneys attached to?
External ilac artery and vein
Eponymous procedure for removal of thyroglossal cyst
Sistruk procedure
resect cyst, tract, central portion of hyoid and wedge of tongue muscle behind the hyoid
Components needed for power calculations
Size of effect
Significance level
Sample size used to detect the effect
Desired power valu
which thyroid tumour spreads via lymphatics
papillary
Drugs causing gynaecomastia
D igitalis
I soniazid
S pironolactone
C imetidine
O estrogen
When to intubate in flail chest?
when saturations < 90
lab test for biliary atresia
conjugated bilirubin
What structure is routinely divided during oesophagectomy
azygos vein
What nerve is at risk in a Holstein lewis fracture
radial
Does kyphoscoliosis cause a restrictive or obstructive picture
restrictive
Where does prostatic cancer spread to
obtruator nodes then internal iliac lymph nodes
Which nerve is most often injured during superficial parotidectomy
greater auricular
What vessel runs across the surface of the abdominal aorta and is often injured during AAA surgery?
left renal vein
Scaphoid abdomen
Bochaldek hernia Trisomy 21 and 18
Morgagni is anterior
Bochaldek - is at the BACK
What structure accompanies the aorta as it goes through the diaphragm?
thoracic duct
How to access right lobe of lung?
6th intercostal space MAL
what can PTFE without miller cuff cause
neo-intimal hyperplasia
Histology of capsule surrounding breast impants
Dystrophic calcification
Boundaries of the deep inguinal ring
inferomedial - inferior epigastric artery
superolateral - Transversalis fascia
locaiton of dorsal ulnar vs superficial radial nerve
ulnar - more medial
radial - more lateral
Osmotic content of lumen greatly affects which part of the GI tract?
Jejunum
Sensation from larynx is by
laryngeal branch of vagus
What is the entire female urethra drained by?
internal iliac nodes
Which nerve lies medially to the lobes of the thyroid gland, in the groove between the oesophagus and trachea
Recurrent laryngeal
Causes of hypoMg
Diuretics
Total parenteral nutrition
Diarrhoea
Alcohol
Hypokalaemia, hypocalcaemia
What are spur cells seen in?
liver or renal faillure
What structure is most at risk in a high anterior resection?
left ureter
Histology of TB
granuloma with central necrosis
Where does genitofemoral nerve exit the abdomen?
deep inguinal ring
order of structures in kidneys
anterior to deep
vein
artery
ureter
What does tunica vaginalise come from
peritoneum
Which type of DCIS is associated with microcalcifications
Comedo
level of the transpyloric plane
L1
What pathogen is assocaited with carcinoma of colon
strep bovis
Which testicular tumour is associated with sex hormone activity?
leydig cell
Which Salter HArris fractures might get confused for each other
1 and 5
How to manage a cystic stump leak post cholecystectomy
ERCP and stent
raised CVP and haemodynamic compromise?
cardiac tamponade
Which part of bowel is involved in Morgagni hernia?
Transverse colon
Extreme abdominal pain followed by bloody diarrhoea
acute mesenteric infarct
Which amputation preserves patella?
gritti stokes
extended right hemi vs left hemi
if obstructed, extended right hemi
What is OCP associated with?
mesenteric venin thrombosis
Which muscles relaxants do NOT cause histamine release
Vecuronium and suxamethonium
Analgesia in advacned pancreatic cancer
nerve block
What causes hypoxia in ARDS
reduced diffusion
Which direction is trachea deviated in during aortic transection
right
Doxorubicin, cold or warm compress?
COLD
Which structure separates the cephalic vein and the brachial artery in the antecubital fossa?
bicipital aponeurosis
best way to destroy spores of tubercle bacili
autoclave
Where is Onufs nucleus found?
anterior horn of S2
Best description of how steroids work in immunity
Binding of intracellular receptors that migrate to the nucleus to then affect gene transcription
What is contained in the rectus sheath?
Pyramadalis
Superior epigastric artery
Superior epigastri vein
Inferior epigastric artery
inferior epigastric vein
Rectus abdominis
Which receptor does pethidine bind to?
Mu
Parts of brachial plexus and the vessels they relate to
The trunks are related to the subclavian artery superiorly. The cords of the plexus surround the axillary artery, they are named according to their positions relative to this structure
Between which two heads of triceps does the radial nerve lie?
lateral and medial
level of IMA
L3
Which clotting time is increased in APLS
APTT
liver lesion with mixed echoity and heterogeneous texture.
liver adenoma
When is burst abdomen most common
6 days
When might a mucous fistula be seen?
They are typically seen following a sub total colectomy where the distal sigmoid colon is deemed too friable to close and it then brought onto the skin as a mucous fistula.
What attached periosteum to bone?
Sharpey’s fibres
first step in intusussception
resuscitate, fluids and ABx
left sided varicocele, abdo USS or scrotal USS
Abdo
conditions associated with anal fissure
Sexually transmitted diseases (syphilis, HIV)
Inflammatory bowel disease (Crohn’s up to 50%)
Leukaemia (25% of patients)
Tuberculosis
Previous anal surgery
What causes Filariasis?
Wuchereria bancrofti
What is the most common location of hypospadias in boys?
opening of distal ventral
Syringomyelia vs Brown Sequard syndrome
Brown Sequard is unilateral
early x-ray findings of perthes disease
sclerosis of femoral head
How many units of heparin to use in graft?
3000 3 minutes before cross clamping
Timeline of post transplant viral (EBV and CMV) ?
CMV 4 weeks to 6 months
EBV > 6 months
Parsonage turner syndrome
rare neuropathy that complicates viral illness
painless blood stained mucous rectal discharge 6 months following a Hartmann’s procedure
Diversion proctitis
symptoms of basilar artery occlusion
vertigo and dysarthria
Which local anaesthetic is not an amino amide type
procaine
Which breast cancer is associated with a marked lymphocytic infiltrate?
Medullary
Compartment syndrome, anticoagulation or no?
no
Saphena varix vs femoral hernia?
saphena varix should be suspected if associated varicose veins
What structure is often mobilised in an oesophagectomy?
azygos vein
What is a known precipitant of pseudogout?
haemochromotosis
When is angioplasty considered?
short disease segment and good vessel run off
Which testicular tumour is assocaited with gynaecomastia?
leydig cell
what accompanies the IVC through diaphragm?
right phrenic nerve
Where are accessory spleens not found?
ureter
necrosis and ulcer of large bowel
entero invasive e coli
Mx of obstructing rectal tumour?
loop colostomy
Which cleft is branchial cyst derived from?
2nd
juvenile polyp aka
hamartoma
what increases secretions of water and electrolytes in pancreatic juice?
secretin
causes of pseudohypoNa
myeloma and hyperlipidaemia
What causes nec fasc?
strep pyogenes
What is malrotation?
rotation of 90 degrees counter lcokwise only
Where does fluid drain after an anterior gastric perf?
right paracolic gutter
Which structure is responsible for coordinated contraction of papillary muscles?
Moderator band
Thiazide diuretic effect on K?
hypokalaemia
What is sural nerve derived from?
both tibial and common fibular
Thymic mass and Myasthenia gravis?
benign thymoma
Which muscles are the last to regain function after a radial nerve palsy?
Extensor pollicis longus and extensor indicis
Which pharyngeal arch gives rise to recurrent laryngeal nerve?
6th
What is the angle between inferior pubic rami in MEN
approx 70 degrees
Ileus vs pseudoobstruction?
ileus = small and large bowel
Pseudo = colon only
Where does aldosterone act?
DCT and collecting duct
Which hormone inhibits lactation during pregnancy?
Progesterone
Psychogenic polydipsia vs diabetes insipidus?
psychogenic - dilutional HYPONa
DI - HYPERNa
What makes parastomal hernia more common?
if brought OUTSIDE of rectus abdominis muscles
characteristic finding of biliary atresia?
absent gallbladder
what causes hypocalcaemia in pancreatitis?
Fat saponification
Which causes osteoporosis, hyper or hypoparathyroidism
HYPER
What is Kohler’s disease?
Osteochondritis of the navicular bone (avascular necrosis)
Complications of mastoiditis?
Dural venous thrombophlebitis
On DRE what is felt posterolateral to prostate?
seminal vesicles
From which embryonic structure is the urachus derived?
Allantois
Where is a pharyngeal pouch most likely to occur?
CricoPHARYNGEUS and thyroPHARYNGEUS
What protein is present in majority of medullary thyroid cancers?
Amyloid
Hodgkin’vs vs Non Hodgkins?
Non Hodgkins = non contiguous lymph node involvement
How does furosemide work at the loop of Henle?
decreased chloride absorption
Most common location for ureteral stone obstruction?
VUJ
Which dermatome is responsible for the referred pain in kidney stones?
L1
Mechanism behind imperforate anus?
Failure of the anal membrane to break down
Which fossa connects the cranial foosa to the pterygopalatine fossa?
Foramen rotundum
What embryonic structue forms the nucleus pulposus?
Notochord
Effect of ACEi on kidney?
Efferent arterial dilation
What makes up the confluence of the sinus?
Straight and superior sagittal
Basilar artery is made from what?
union of two vertebral arteries
Description of Salmonella
gram negative rod
Where does thyroglossal cyst originate from?
Foramen caecum
What tendon is used in ACL reconstruction?
Semitendinosus
What structure can cause bleedingi nmidline sternotomy?
right brachiocephalic vein
What is the H structure on visceral side of liver?
Gallbladdder, IVC, ligamentum venosum, ligamentum teres, porta hepatis
What common electrolyte abnormality is seen in thyrotoxicosis?
hyperCA
partial 21 hydroxylase deficiency vs complete?
complete - salt wasting - unable to produce aldosterone and leads to an earlier presentaiton
What is a specific complication of angioplasty?
pseudoaneurysm
Benefit of open repair vs EVAR
EVAR requires long term follow up
mycotic aneurysm
staph aureus
After how many weeks gestation does the fundus of the uterus pass above the pelvis brim
12
Approach for hemiarthroplasty in trauma?
Hardinge
Approach for THR
Posterior
How to check a rectal anastomosis?
water soluble contrast enema
Tx for basicervical NOF?
DHS
What is Homan’s sign?
Passive dorsiflexion of oot causes pain in calf, DVT
Which nerve is involved in Frey syndrome?
Auriculotemporal
McMurray’s test?
MENISCAL TEAR
Complication of mastoiditis?
Sigmoid sinus thrombophlebitis
Which type of burns are included in the parkland formula?
deep partial and full thickness only
Teardrop mass in foot
morton neuroma
Management of full thickness burn
early surgical excision of burn wound, delayed closure with split skin autograft
What is the most common type of facial BCC?
Nodular
Osgood Schlatter vs OCD
OS - tibilar tuberosity
OCD - medial condyle
Rotator cuff tear vs supraspinatus tendinitis
RC tear - reduced active ROM Supraspinatus - pain between 60-120 (painful arc)
Location to block ilioinguinal and iliohypogastric nerves?
2cm medial and 2cm cephalad (toward head) from ASIS
What is exampholos associated with?
ToF
Do Nitrates affect arteries or veins more?
veins
What two things reduce myocardial flow?
pain and vasopressin
Which part of ECG shows ventricular reporlarisation?
T wave
Most superficial structure in parotid gland?
Facial nerve
How do macrolides work
Protein synthesis inhibitions
thinks gym MACROS
Buzz word for GvHD?
desquamation
What forms the superolateral and inferomedial walls of the deep inguinal ring?
SL - Transversalis fascia
IM - Inferior epigastric
What is the level of the left main bronchus?
T6
Which structure separates the cephalic vein and brachia artery in the antecubital fossa?
bicipital aponeurosus
What are patients with AAA at risk of developing?
Mural thrombus
When is nerve grafting required?
Injuries > 2.5cm
Post splenic laceration, SOB and dysphagia?
Diaphragmatic rupture
Which anaesthetic causes a rise in BP and HR?
Ketamine
Assocaited injury with fracture of sternum?
myocardial contusion
When is fascicular nerve repair indicated?
medial or ulnar nerve injury in distal third of forearm
Sciatic nerve injury in the thigh
Ix to detect retained stone?
MRCP
Bone appearance in prostate met vs breat met
prostate - sclerotic
breast - lytic
Which ligament is involved in lumbar canal stenosis?
Ligamentum Flavum
What condition is associated with hyperplastic arteriosclerosis and malignant hypertension?
diffuse scleroderma
How can acute tubular dysfunction of kidney be treated?
osmotic diuretics
affects medulla with low urine osmolality
Describe hyperacute reaction
complement mediated
what does b12 do?
involved in red cell maturation
Where does medulloablastoma typically originate in children?
cerebral vermis
What kind of anaemia does acute haemorrhage cause?
megaloblastic
how does IPPV affect cardiac output?
decreases it
What site is affected in peyronie’s disease?
tunica albguinea
what is given in hereditary angioedema?
FFP
Classic signs of haemolysis following transfusion
Haemolysis of the transfused cells occurs causing the combination of shock, haemoglobinaemia and loin pain
What does all collagen have?
Glycin
under which fascila layer in the ansa cervicalis?
pre tracheal
levle 3 breast nodea, bleeding?
thoracoacromial artery
Features of gastric volvulus
retching but no vomiting
abdominal tenderness
unable to pass NG tube
What type of Ca do wood workers develop?
paranasal sinus Ca
otitic hydrocephalus
following middle ear infection without brain abscess
headache, abducens palsy and papilloedema
meningocele vs myelomeningocele?
presence of cord is myelo
What is an absolute contrainidcation to surgery in vein incompetence?
scan showing occluded deep vessels
Histology of fibroadenoma of breast
apocrine metaplasia and papillary overgrowth
interrupted aortic arch signs
cyanosis, absent or weak femoral pulse
What causes dark urine and pale stool in obstructive jaundice?
urine - incerased conjugated biliruibin which is water soluble
pale stool - decreased bilirubin entering the gut
What surrounds a hydrocele in an adults
TUNICA vaginalis
anatomical location of cricothyroid membrane?
halfway between jugular notch and hyoid
What structure might be divided in the deltopectoral groove?
thoracoacromial artery
Where does the sural nerve pass in relation to the lateral malleolus?
posterior
How is the ischiorectal fossa related to the pudendal canal?
IR is medial to PC
What structures are pierced in an LP?
skin, subcutaneous tissue, supraspinous ligament, interspinous ligament, ligamentum flavum, epidural space containing the internal vertebral venous plexus, dura, arachnoid, and finally the subarachnoid space
When is coronary artery flow highest?
during ventricular diastole
How does cirrhosis lead to thrombocytopaenia?
sequestration in the spleen
What happens to CO in a transplanted heart?
increases due to increase in stroke volume
Effects of IPPV
increased in intrathoracic pressure
decrease in CO
Skull findings in multiple myeloma
lytic lesions
What causes post op paralytic ileus
stimulation of p receptors
extreme complication of TPN?
pancytopaenia due to folate deficiency
What are torted testes fixed to?
tunica vaginalis
what reduces risk fo posterior dislocation of hip?
Allis
When to not give adrenaline with LA?
if on MAOi or TCAs
PAOP related to which chamber in the heart?
left atrium
how does potassium affect renin?
hyperK inhibits renin and promotes aldosterone
hypoK promotes renin and inhibits aldosterone
how does hyperventilation affect calcium
LOW calcium
Which one increases venous return to heart, inspiration or expiration?
inspiration
Where is blood ‘stolen from’ in subclavian steal syndrome?
vertebral
Which cancers produce lytic bone lesions?
Renal
Breast
Myeloma
Side effect of alkylating chemo agents
gout
which thyroid cancer is associated with childhood radiation?
papillary
SAAG: transudate vs exudate
low = exudate
high = transudate
Which drug can cause sialomegaly?
Carbimazole
Testicular mass with lymphocytic stromal infiltrate
classical seminoma
Side effect of neostigmine
bradycardia
which carpal bone dislocation can cause median nerve neuropathy?
lunate
What does succasion spash indicate?
gastric outlet obstruction
Glomerular pressure formula
(Pc - Pb) - piC
What can be used to prevent cystein stone formation?
pencillamine
Suxamethonium vs Hexamethonium?
Suxamethonium is PRE synaptic
Hexamethonium is POST synaptic (non depolarising)
Which structure prevents movement of horseshoe kidney to its correct position?
IMA
Severe complication in nephrotic syndrome
SBP with strep pneumoniae
